Jeong Bong Kim, Jae Hwan Cho, Jae Woo Park, Jin Hoon Park, Seung Hyun Baek, Tae Hyoung Kim, Sehan Park, Chang Ju Hwang, Dong-Ho Lee
{"title":"导致转移性脊髓压迫术后出现症状性局部复发的因素有哪些？","authors":"Jeong Bong Kim, Jae Hwan Cho, Jae Woo Park, Jin Hoon Park, Seung Hyun Baek, Tae Hyoung Kim, Sehan Park, Chang Ju Hwang, Dong-Ho Lee","doi":"10.1186/s13018-024-05289-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Risk factors for local recurrence in patients with metastatic spinal cord compression (MSCC) has not been clearly investigated. So, the purpose of this study was to identify risk factors causing local recurrence following surgeries in patients with MSCC.</p><p><strong>Methods: </strong>We conducted a retrospective comparative study on 304 patients who underwent surgery for MSCC between March 2014 and February 2020. Local recurrence rate (LRR) was analyzed according to demographic variables, radiological variables such as level of spinal metastasis, number of non-spinal bone metastases, degree of spinal cord compression, spinal instability, and pathological fracture, and treatment-related variables such as origin of tumor, surgical treatment methods, and pre- and post- operative radiation therapy. Univariate and multivariate logistic regression analyses were performed to reveal the risk factors for local recurrence.</p><p><strong>Results: </strong>Among 304 patients with MSCC, 50 patients (16.4%) experienced local recurrence after surgery. Of the surgical methods, decompression alone (26/50, 52.0%) showed higher LRR compared to decompression with fixation (9/177, 5.1%) or corpectomy (11/89, 12.4%), (P = 0.002 and P = 0.018, respectively). Patients with renal cell carcinoma revealed higher LRR compared to other types (P = 0.014). It was found that the 3 or more level of spinal metastasis (P = 0.001), the 3 or more of extraspinal bone metastases (P = 0.028), and pathologic fracture (P = 0.003) were related with higher LRR. Smoking is also an independent risk factor for local recurrence in patients who underwent fixation (P = 0.026).</p><p><strong>Conclusions: </strong>Symptomatic local recurrence may be influenced by several factors, including the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin (RCC). These factors should be carefully considered by surgeons when evaluating the risk of symptomatic local recurrence after surgery.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"19 1","pages":"775"},"PeriodicalIF":2.8000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577859/pdf/","citationCount":"0","resultStr":"{\"title\":\"What are the factors contributing to symptomatic local recurrence in metastatic spinal cord compression after surgery?\",\"authors\":\"Jeong Bong Kim, Jae Hwan Cho, Jae Woo Park, Jin Hoon Park, Seung Hyun Baek, Tae Hyoung Kim, Sehan Park, Chang Ju Hwang, Dong-Ho Lee\",\"doi\":\"10.1186/s13018-024-05289-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Risk factors for local recurrence in patients with metastatic spinal cord compression (MSCC) has not been clearly investigated. So, the purpose of this study was to identify risk factors causing local recurrence following surgeries in patients with MSCC.</p><p><strong>Methods: </strong>We conducted a retrospective comparative study on 304 patients who underwent surgery for MSCC between March 2014 and February 2020. Local recurrence rate (LRR) was analyzed according to demographic variables, radiological variables such as level of spinal metastasis, number of non-spinal bone metastases, degree of spinal cord compression, spinal instability, and pathological fracture, and treatment-related variables such as origin of tumor, surgical treatment methods, and pre- and post- operative radiation therapy. Univariate and multivariate logistic regression analyses were performed to reveal the risk factors for local recurrence.</p><p><strong>Results: </strong>Among 304 patients with MSCC, 50 patients (16.4%) experienced local recurrence after surgery. Of the surgical methods, decompression alone (26/50, 52.0%) showed higher LRR compared to decompression with fixation (9/177, 5.1%) or corpectomy (11/89, 12.4%), (P = 0.002 and P = 0.018, respectively). Patients with renal cell carcinoma revealed higher LRR compared to other types (P = 0.014). It was found that the 3 or more level of spinal metastasis (P = 0.001), the 3 or more of extraspinal bone metastases (P = 0.028), and pathologic fracture (P = 0.003) were related with higher LRR. Smoking is also an independent risk factor for local recurrence in patients who underwent fixation (P = 0.026).</p><p><strong>Conclusions: </strong>Symptomatic local recurrence may be influenced by several factors, including the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin (RCC). These factors should be carefully considered by surgeons when evaluating the risk of symptomatic local recurrence after surgery.</p>\",\"PeriodicalId\":16629,\"journal\":{\"name\":\"Journal of Orthopaedic Surgery and Research\",\"volume\":\"19 1\",\"pages\":\"775\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-11-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577859/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Surgery and Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13018-024-05289-4\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Surgery and Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13018-024-05289-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
What are the factors contributing to symptomatic local recurrence in metastatic spinal cord compression after surgery?
Background: Risk factors for local recurrence in patients with metastatic spinal cord compression (MSCC) has not been clearly investigated. So, the purpose of this study was to identify risk factors causing local recurrence following surgeries in patients with MSCC.
Methods: We conducted a retrospective comparative study on 304 patients who underwent surgery for MSCC between March 2014 and February 2020. Local recurrence rate (LRR) was analyzed according to demographic variables, radiological variables such as level of spinal metastasis, number of non-spinal bone metastases, degree of spinal cord compression, spinal instability, and pathological fracture, and treatment-related variables such as origin of tumor, surgical treatment methods, and pre- and post- operative radiation therapy. Univariate and multivariate logistic regression analyses were performed to reveal the risk factors for local recurrence.
Results: Among 304 patients with MSCC, 50 patients (16.4%) experienced local recurrence after surgery. Of the surgical methods, decompression alone (26/50, 52.0%) showed higher LRR compared to decompression with fixation (9/177, 5.1%) or corpectomy (11/89, 12.4%), (P = 0.002 and P = 0.018, respectively). Patients with renal cell carcinoma revealed higher LRR compared to other types (P = 0.014). It was found that the 3 or more level of spinal metastasis (P = 0.001), the 3 or more of extraspinal bone metastases (P = 0.028), and pathologic fracture (P = 0.003) were related with higher LRR. Smoking is also an independent risk factor for local recurrence in patients who underwent fixation (P = 0.026).
Conclusions: Symptomatic local recurrence may be influenced by several factors, including the extent of spinal and extraspinal bone metastasis, pathologic fractures, surgical approach, and tumor origin (RCC). These factors should be carefully considered by surgeons when evaluating the risk of symptomatic local recurrence after surgery.
期刊介绍：
Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues.
Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications.
JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.
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