Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ)
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RESEARCH ARTICLE
Open Access
Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ) Zemin Li1, Houqing Long1*, Rui Guo2, Jinghui Xu1, Xiaobo Wang1, Xing Cheng1, Yangliang Huang1 and Fobao Li1
Abstract Background: The cervicothoracic junction (CTJ) site accounts for approximately 10% of all spinal metastases. The complex anatomical and biomechanical features increase the difficulty in surgical treatment of the CTJ metastases. However, few studies in the literature on surgical treatment for spinal metastases are focusing on this special area. The aim of this study was to evaluate the surgical outcome of patients with CTJ metastases and analyze the prognostic factor for the postoperative survival. Methods: Total of 34 patients with CTJ metastases who underwent surgery in our department were retrospectively analyzed. We evaluated records for the details of medical history, treatment, surgery, radiographic imaging, and follow-up. Outcomes were assessed by overall survival as well as modified Tokuhashi score, SINS, Frankel grade, visual analog scale (VAS), and Karnofsky Performance Status (KPS). Results: The entire patients’ median survival time was 12.4 months (range, 3.5–36.2 months). Pain improved in 32 patients (94.12%), and the postoperative VAS scores were significantly improved compared with preoperative data. Majority of patients (71%) maintained or improved their Frankel scores 1 year after surgery. KPS scores improved in 13 patients (38%), remained stable in 19 (56%), and worsened in 2 (6%) postoperatively. Notably, patients with neurological deficit that did not improve after surgery had significantly worse median survival than those who had either no deficit or who improved after surgery. There were no instrumentation failures in this study. Conclusions: Surgical treatment is effective for patients of CTJ metastases, with a tolerable rate of complications. Remained or regained ambulatory status predicted overall survival. Thus, prompt and aggressive decompressive surgery is recommended for CTJ metastases patients with neurological impairment. Keywords: Spinal metastases, Cervicothoracic junction, Surgical treatment, Survival, Retrospective study
Background The spine is the most common site for bony metastases [1]. About 10–30% of the cancer patients are attained by spinal metastases [2, 3]. The incidence of spinal metastases continues to increase, likely a result of improvement in medical treatment and increasing survival times [2]. Among the adults, 60% of spinal metastases are either from breast, lung, or prostate cancer [4]. About one third * Correspondence: [email protected] 1 Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Full list of author information is available at the end of the article
of these spinal metastases become symptomatic, which is causing pain, neurological deficits, and biomechanical instability requiring surgical treatment [5]. The aim of surgery in such patients
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