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Acta Neurochirurgica

, Volume 161, Issue 6, pp 1069–1076 | Cite as

The “Friday peak” in surgical referrals for spinal metastases: lessons not learned. A retrospective analysis of 201 consecutive cases at a tertiary center

  • Bertrand DebonoEmail author
  • Cécile Braticevic
  • Pascal Sabatier
  • Guillaume Dutertre
  • Igor Latorzeff
  • Olivier Hamel
Original Article - Spine - Other
Part of the following topical collections:
  1. Spine - Other

Abstract

Background

Spinal cord compression and fracture are potential complications of spine metastasis (SM). Rapid management by an expert team can reduce these adverse developments. Delays in seeking therapeutic advices, which lead to the need for sub-optimal emergency procedures, were already demonstrated nearly 20 years ago. We aimed to analyze the current weak points of referrals for vertebral metastasis so as to improve the care pathways.

Methods

We retrospectively reviewed the data of all patients admitted on an emergency or elective basis who underwent palliative surgery for the treatment of neoplastic spine lesions in our institution (tertiary referral neurosurgical unit) between January 2009 and December 2016.

Results

This retrospective study included 201 patients, 121 men and 80 women (mean age 65.1 years ± 10.9). Cancer was known for 59.7% of cases. Patients were neurologically asymptomatic in 52.7% of cases (Frankel E), and 123 (60.7%) were hospitalized for emergency reasons, including 51 (41.5% of emergencies) on a Friday (p < 0.0001). A significant increase in emergencies occurred over the studied period (p = 0.0027). The “emergency” group had significantly unfavorable results in terms of neurological status (p < 0.001), the occurrence of complications (p = 0.04), the duration of hospitalization (p = 0.02), and the clinical evolution (p = 0.04). Among 123 patients hospitalized for emergency reasons, 65 (52.8%) had known cancers, of which 33 had an identified SM, including 22 with neurological deficits (Frankel A–D), without prior surgical assessment (17.8% of emergencies).

Conclusion

Too many patients with previously identified metastases are referred for emergency reasons, including with a neurological deficit. Optimizing upstream pathways and referrals is imperative for improving the management of these patients. Involving a spine surgeon at the slightest symptom or an abnormal image is critical for defining the best treatment upstream. The use of telemedicine and the development of dedicated tumor boards are ways of improving this involvement.

Keywords

Spine Tumor Metastasis Spinal cord compression Multidisciplinary meeting Tumor board Referral Spine surgery Decompression Emergency 

Abbreviations and acronyms

EBM

Evidence-based medicine

KPS

Karnofsky performance status

LOS

Length of stay

MRI

Magnetic resonance imaging

SM

Spinal metastasis

Notes

Acknowledgements

The authors thank Drs. Jean-Paul Lescure and Philippe Bousquet for their neurosurgical support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Neuroscience PoleCapio - Clinique des CèdresCornebarrieuFrance
  2. 2.Department of Medical OncologyInstitut Paoli-CalmettesMarseilleFrance
  3. 3.Surgical Oncology DepartmentInstitut Curie, PSL Research UniversityParisFrance
  4. 4.Department of Radiotherapy, Groupe ONCORAD GaronneClinique PasteurToulouseFrance

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