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Text
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<a href="http://doi.org/10.1016/j.clineuro.2019.105574" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.clineuro.2019.105574</a>
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Pages
105574
Volume
188
ISSN
1872-6968
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<a href="http://ezproxy.neomed.idm.oclc.org/login?url=http://doi.org/10.1016/j.clineuro.2019.105574" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1016/j.clineuro.2019.105574</a>
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Title
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Non-operative management of spinal metastases: A prognostic model for failure
Publisher
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Clinical Neurology And Neurosurgery
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019-11-04
Subject
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Prognosis; Survival; Surgery; Spinal metastases; Ambulatory function; Non-operative treatment
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Schoenfeld Andrew J; Schwab Joseph H; Ferrone Marco L; Blucher Justin A; Balboni Tracy A; Barton Lauren B; Chi John H; Kang James D; Losina Elena; Katz Jeffrey N
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OBJECTIVES: To describe patient-specific characteristics associated with non-operative failure leading to surgery. PATIENTS AND METHODS: We conducted a retrospective review of patients treated for spinal metastases from 2005 to 2017. We deemed patients as failures if they were treated non-operatively and then received a surgical intervention within one year of starting a non-operative regimen. We used multivariable Poisson regression to identify factors associated with non-operative failure. We conducted internal validation using bootstrapping with 1000 replications. RESULTS: We identified 1205 patients with spinal metastases, of whom 834 were initially treated non-operatively and constituted the analytic sample. Of these 77 (9%) went on to have surgery within 1-year of presentation and were deemed non-operative treatment failures. We identified vertebral body collapse and/or pathologic fracture (adjusted Risk Ratio [RR] 1.75; 95% Confidence Interval [CI] 1.11, 2.76) and neurologic signs or symptoms at presentation (RR 1.90; 95% CI 1.19, 3.03) as factors independently associated with an increased risk of non-operative failure. Platelet-lymphocyte ratio >155, a marker for inflammatory state, was also associated with an increased risk of failure (RR 2.32; 95% CI 1.15, 4.69). Failure rates among those with 0, 1, 2 or all three of these risk factors were 5%, 7%, 12% and 20%, respectively (p = 0.004). CONCLUSION: We found that 9% of patients with spinal metastases initially treated non-operatively received surgery within 1-year of commencing care. The likelihood of surgery increased with the number of risk factors. These results can be used in counseling and shared decision making at the time of initial presentation.
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<a href="http://doi.org/10.1016/j.clineuro.2019.105574" target="_blank" rel="noreferrer noopener">10.1016/j.clineuro.2019.105574</a>
PMID: 31707291
Format
The file format, physical medium, or dimensions of the resource
Journal Article
2019
Ambulatory function
Balboni Tracy A
Barton Lauren B
Blucher Justin A
Chi John H
Clinical Neurology and Neurosurgery
Ferrone Marco L
Journal Article
Kang James D
Katz Jeffrey N
Losina Elena
NEOMED Alumnus
NEOMED College of Medicine
Non-operative treatment
November 2019 Update
Prognosis
Schoenfeld Andrew J
Schwab Joseph H
Spinal metastases
Surgery
Survival
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Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.1016/j.spinee.2019.10.021" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.spinee.2019.10.021</a>
Rights
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
ISSN
1878-1632
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Locate full-text within NEOMED Library's e-journal collections
<a href="http://ezproxy.neomed.idm.oclc.org/login?url=http://doi.org/10.1016/j.spinee.2019.10.021" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.1016/j.spinee.2019.10.021</a>
<p>Users with a NEOMED Library login can search for full-text journal articles at the following url: <a href="https://libraryguides.neomed.edu/home">https://libraryguides.neomed.edu/home</a></p>
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Title
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Design of the Prospective Observational Study of spinal metastasis Treatment (POST)
Publisher
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The Spine Journal: Official Journal Of The North American Spine Society
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
2019-11-08
Subject
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decision making; Spinal metastases; NESMS; POST; predictive score
Creator
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Schoenfeld Andrew J; Blucher Justin A; Barton Lauren B; Schwab Joseph H; Balboni Tracy A; Chi John H; Shin John H; Kang James D; Harris Mitchel B; Ferrone Marco L
Description
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BACKGROUND CONTEXT: There are several prognostic scores available that intend to inform decision making for patients with spinal metastases. Many of these have not been found to reliably predict survival across the continuum of care. Recently, our group developed the New England Spinal Metastasis Score (NESMS). While the NESMS demonstrated many of the necessary attributes of a useful prediction tool, it has yet to be validated prospectively. PURPOSE: To describe the Prospective Observational study of Spinal metastasis Treatment (POST). This investigation examined the performance of the NESMS, compared its predictive capacity to other scoring systems and determined its ability to identify patients who benefit the most from surgery. STUDY DESIGN: Prospective observational study at two medical centers. PATIENT SAMPLE: Patients age 18 and older with spinal metastases involving the spine. OUTCOME MEASURES: Survival, post-treatment morbidity and health related quality of life (HRQL) outcomes. METHODS: The POST study assessed patients at baseline and at 1-month, 3-month, 6-month and 12-month time-points. During the baseline assessment patient demographics, past medical history and assessment of co-morbidities, surgical history, primary tumor histology and ambulatory status were recorded along with the designated treatment strategy (e.g. operative or non-operative). The NESMS and other predictive scores for each patient were calculated based on baseline data. Study-specific surveys administered at all time-points consisted of the EuroQuol 5-Dimension and Short-Form (SF)-12, Visual Analog Scale (VAS) for pain and PROMIS assessment of global health. RESULTS: Two hundred patients were enrolled in POST from 2017-2019. Patients were followed to one of the two pre-determined study end-points (i.e. mortality, or completion of the 12-month follow-up). Survival was considered the principle dependent variable. Post-treatment morbidity and HRQL outcomes were considered secondarily. Analyses, by aim, relied on Cox proportional hazards regression, repeated measures logistic regression, propensity score matching and multivariable logistic regression. CONCLUSION: The POST's findings are anticipated to provide evidence regarding the prognostic capabilities of the NESMS as well as that of other popular grading schemes for survival, post-treatment complications and physical as well as mental function.
Identifier
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<a href="http://doi.org/10.1016/j.spinee.2019.10.021" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2019.10.021</a>
PMID: 31712164
Format
The file format, physical medium, or dimensions of the resource
Journal Article
2019
Balboni Tracy A
Barton Lauren B
Blucher Justin A
Chi John H
Decision Making
Ferrone Marco L
Harris Mitchel B
Journal Article
Kang James D
NEOMED Alumnus
NEOMED College of Medicine
NESMS
November 2019 Update
POST
predictive score
Schoenfeld Andrew J
Schwab Joseph H
Shin John H
Spinal metastases
The Spine Journal: Official Journal Of The North American Spine Society