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Efficacy Evaluation of a New Treatment Algorithm for Spinal Metastases

Gasbarrini, Alessandro MD*; Li, Haomiao MD; Cappuccio, Michele MD; Mirabile, Loris MD*; Paderni, Stefania MD; Terzi, Silvia MD*; Boriani, Stefano MD*

doi: 10.1097/BRS.0b013e3181c680b9
Clinical Case Series

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.

To evaluate the efficacy of a new treatment algorithm for spinal metastases, a semiprospective study was performed in comparison with 2 groups treated at different time. The superiority of the algorithm was validated preliminarily by the significantly longer survival time and better long-time neurologic evolvement in the prospective study group.

From the *Department of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy; †Orthopedic Department, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; and ‡Department of Orthopedics and Traumatology-Spine Surgery, Ospedale Maggiore “C.A. Pizzardi,” Bologna, Italy.

Acknowledgment date: March 4, 2009. Revision date: July 26, 2009. Acceptance date: September 2, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The authors A. G. and H. L. have contributed equally to the article.

Address correspondence and reprint requests to Alessandro Gasbarrini, MD, Department of Oncologic and Degenerative Spine Surgery, Rizzoli Istitute, Via Pupilli 1, Bologna 40136, Italy; E-mail: or

© 2010 Lippincott Williams & Wilkins, Inc.