A new study published in Clinical Spine Surgery examines spinal tumor treatment at high-volume centers.
The study authors examined 1,681 patients with spinal tumors who were treated from 1990 to 2015. All patients were treated by the same clinical team. Most of the patients — 77.8 percent — were treated at a single institution and considered noncontaminated cases. The remaining 22.2 percent were treated elsewhere previously and considered contaminated cases. Here are the key results:
1. Over the study period, 216 patients underwent 220 en bloc resections, with most being primary tumors. Of the 165 primary tumors treated, 43 were benign and 122 were malignant.
2. Study authors recorded 33 local recurrences, with 14 recurrences coming from the contaminated cases and 19 coming from the noncontaminated cases.
3. Overall, 100 of the patients reported 153 complications during the study period. Around two-thirds of the patients suffered one complication while the remaining reported two or more complications. More than half — 58 percent — of the contaminated group reported complications, compared with 42.85 percent of the noncontaminated group.
4. During the study period, 60 patients died as a result of their spinal tumors; 43.75 percent of the contaminated case patients and 23.21 percent of the noncontaminated patients died during the follow-up period.
5. The independent risk factors for patient death were:
• Local recurrence
• Contamination
• Neoadjuvant radiotherapy
• Levels resected
• Metastatic tumor compared with primary malignant tumor
"It appears there is a substantial added risk in performing either invasive diagnostic procedures or attempting a surgical resection of the tumor in a nonspecialized center," concluded the study authors. "The risk includes both higher recurrences of the tumor as well as increased mortality. It is therefore reasonable to conclude that the whole treatment, from biopsy to resection, should be performed at the same center, and this center should be high volume, specialized in treating these types of spine pathologies."