Efficacy evaluation of a new treatment algorithm for spinal metastases

Study Design. A semiprospective clinical study was conducted. Objective. To evaluate the efficacy of a new treatment algorithm for spinal metastases. Summary of Background Data. The surgical treatments in spinal metastatic have been progressing in recent years, while the surgical indications have been controversial. A new treatment algorithm for spinal metastases was developed and prospectively applied clinically in our department since 2002. Methods. This study included 202 patients with 206 lesions treated in January 1997 to December 2006 and continuously followed-up for more than 6 months or dead within this period. A total of 124 patients with 124 lesions were operated before 2002 were allocated to the control group and 78 patients with 82 lesions prospectively treated after 2002 were allocated to the prospective study group. The primary managements were nonsurgical treatment, palliative surgery, debulking, and en bloc resection. Neurologic evolvement, postoperative survival time, and local recurrence/development rates were statistically compared as the indexes of treatment outcome. Results. Although there was no significant difference of neurologic evolvement immediately after operation (P = 0.24), the prospective study group achieved significantly better neurologic function than the control group long time after operation (P = 0.03). No significant difference (P = 0.26) was shown in local recurrence/development rate comparison. The mean postoperative survival time comparison showed significant difference (P <0.01). Conclusion. The efficacy of the algorithm has been validated preliminarily by the significantly longer survival time and better long-time neurologic function evolvement in the prospectively study group. But the algorithm should continuously be in development and be updated with the latest improvement in metastatic treatment.