Skip to main content

Advertisement

Log in

Application of the NSE score (Neurology-Stability-Epidural compression assessment) to establish the need for surgery in spinal metastases of elderly patients: a multicenter investigation

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

This retropective multicentric study aims to investigate the clinical applicability of the NSE score in the elderly, to verify the role of this tool as an easy help for decision making also for this class of patients.

Methods

All elderly patients (> 65 years) suffering from spinal metastases undergoing surgical or non-surgical treatment at the authors’ Institutions between 2015 and 2022 were recruited. An agreement group (AG) and non-agreement group (NAG) were identified accordingly to the agreement between the NSE score indication and the performed treatment. Neurological status and axial pain were evaluated for both groups at follow-up (3 and 6 months). The same analysis was conducted specifically grouping patients older than 75 years.

Results

A strong association with improvement or preservation of clinical status (p < 0.001) at follow-up was obtained in AG. The association was not statistically significant in NAG at the 3-month follow-up (p 1.00 and 0.07 respectively) and at 6 months (p 0.293 and 0.09 respectively). The group of patients over 75 years old showed similar results in terms of statistical association between the agreement group and better outcomes.

Conclusion

Far from the need or the aim to build dogmatic algorithms, the goal of preserving a proper performance status plays a key role in a modern oncological management: functional outcomes of the multicentric study group showed that the NSE score represents a reliable tool to establish the need for surgery also for elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Advancing Cancer Therapy (2021) Nat Cancer 2:245–246. https://doi.org/10.1038/s43018-021-00192-x

    Article  Google Scholar 

  2. - Kowdley GC, Merchant N, Richardson JP, Somerville J, Gorospe M, Cunningham SC (2012) Cancer surgery in the elderly. ScientificWorldJournal 2012:303852. https://doi.org/10.1100/2012/303852

    Article  PubMed  PubMed Central  Google Scholar 

  3. Aebi M (2003) Spinal metastasis in the elderly. Eur Spine J 12(Suppl 2):S202–S213. https://doi.org/10.1007/s00586-003-0609-9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Beaufort Q, Terrier LM, Dubory A et al (2021) Spine metastasis in Elderly: encouraging results for Better Survival. Spine (Phila Pa 1976) 46(11):751–759. https://doi.org/10.1097/BRS.0000000000003881

    Article  PubMed  Google Scholar 

  5. Hussain I, Hartley BR, McLaughlin L et al Surgery for metastatic spinal disease in octogenarians and above: analysis of 78 patients. Global Spine J 2021 Oct 20:21925682211037936. https://doi.org/10.1177/21925682211037936

  6. Newman WC, Bilsky MH (2022) Fifty-year history of the evolution of spinal metastatic disease management. J Surg Oncol 126(5):913–920. https://doi.org/10.1002/jso.27028

    Article  PubMed  Google Scholar 

  7. Cofano F, Monticelli M, Ajello M et al (2019 Jan-Dec) The targeted therapies Era beyond the Surgical Point of View: what spine surgeons should know before approaching spinal metastases. Cancer Control 26(1):1073274819870549. https://doi.org/10.1177/1073274819870549

  8. Cofano F, Di Perna G, Marengo N et al (2020) Transpedicular 3D endoscope-assisted thoracic corpectomy for separation surgery in spinal metastases: feasibility of the technique and preliminary results of a promising experience. Neurosurg Rev 43(1):351–360. https://doi.org/10.1007/s10143-019-01204-2

    Article  PubMed  Google Scholar 

  9. Cofano F, Di Perna G, Monticelli M et al (2020) Carbon fiber reinforced vs titanium implants for fixation in spinal metastases: a comparative clinical study about safety and effectiveness of the new carbon-strategy. J Clin Neurosci 75:106–111. https://doi.org/10.1016/j.jocn.2020.03.013

    Article  CAS  PubMed  Google Scholar 

  10. Di Perna G, Cofano F, Mantovani C et al (2020) Separation surgery for metastatic epidural spinal cord compression: a qualitative review. J Bone Oncol 25:100320. https://doi.org/10.1016/j.jbo.2020.100320

    Article  PubMed  PubMed Central  Google Scholar 

  11. Cofano F, Di Perna G, Zenga F et al (2020) The Neurology-Stability-Epidural compression assessment: A new score to establish the need for surgery in spinal metastases. Clin Neurol Neurosurg. ;195:105896. https://doi.org/10.1016/j.clineuro.2020.105896. Epub 2020 May 19. Erratum in: Clin Neurol Neurosurg. 2021;205:106673

  12. Laufer I, Rubin DG, Lis E et al (2013) The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 18(6):744–751. https://doi.org/10.1634/theoncologist.2012-0293

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gasbarrini A, Li H, Cappuccio M, Mirabile L, Paderni S, Terzi S, Boriani S (2010) Efficacy evaluation of a new treatment algorithm for spinal metastases. Spine (Phila Pa 1976) 35(15):1466–1470. https://doi.org/10.1097/BRS.0b013e3181c680b9. Erratum in: Spine (Phila Pa 1976). 2011;36(2):179

    Article  PubMed  Google Scholar 

  14. Sabharwal S, Wilson H, Reilly P, Gupte CM (2015) Heterogeneity of the definition of elderly age in current orthopaedic research. Springerplus 4:516. https://doi.org/10.1186/s40064-015-1307-x

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fisher CG, DiPaola CP, Ryken TC et al (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 35(22):E1221–E1229. https://doi.org/10.1097/BRS.0b013e3181e16ae2

    Article  PubMed  Google Scholar 

  16. Bilsky MH, Laufer I, Fourney DR et al (2010) Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 13(3):324–328. https://doi.org/10.3171/2010.3.SPINE09459

    Article  PubMed  Google Scholar 

  17. Anekar AA, Hendrix JM, Cascella M (2023) WHO Analgesic Ladder. [Updated 2023 Apr 23]. StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL)

    Google Scholar 

  18. Cofano F, Di Perna G, Alberti A et al (2020) Neurological outcomes after surgery for spinal metastases in symptomatic patients: does the type of decompression play a role? A comparison between different strategies in a 10-year experience. J Bone Oncol 26:100340. https://doi.org/10.1016/j.jbo.2020.100340

    Article  PubMed  PubMed Central  Google Scholar 

  19. Amelot A, Balabaud L, Choi D et al (2017) Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery! Spine J 17(6):759–767. https://doi.org/10.1016/j.spinee.2015.07.440

    Article  CAS  PubMed  Google Scholar 

  20. De la - R, Goodwin CR, Jain A, Abu-Bonsrah N, Fisher CG, Bettegowda C, Sciubba DM (2016) Development of a metastatic spinal tumor Frailty Index (MSTFI) using a Nationwide Database and its Association with Inpatient Morbidity, Mortality, and length of stay after spine surgery. World Neurosurg 95:548–555e4. https://doi.org/10.1016/j.wneu.2016.08.029

    Article  Google Scholar 

  21. Massaad E, Williams N, Hadzipasic M et al (2021) Performance assessment of the metastatic spinal tumor frailty index using machine learning algorithms: limitations and future directions. Neurosurg Focus 50(5):E5. https://doi.org/10.3171/2021.2.FOCUS201113

    Article  PubMed  Google Scholar 

  22. MacLean MA, Georgiopoulos M, Charest-Morin R et al AO Spine Knowledge Forum Tumor. Perception of frailty in spinal metastatic disease: international survey of the AO Spine community. J Neurosurg Spine 2023 Mar 3:1–11. https://doi.org/10.3171/2023.1.SPINE221433

  23. Li G, Patil CG, Lad SP, Ho C, Tian W, Boakye M (2008) Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine (Phila Pa 1976) 33(11):1250–1255. https://doi.org/10.1097/BRS.0b013e3181714a44

    Article  PubMed  Google Scholar 

  24. Raffo CS, Lauerman WC (2006) Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine (Phila Pa 1976) 31(1):99–103. https://doi.org/10.1097/01.brs.0000192678.25586.e5

    Article  PubMed  Google Scholar 

  25. Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA (1992) Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am 74:536–543

    Article  CAS  PubMed  Google Scholar 

  26. Reindl R, Steffen T, Cohen L, Aebi M (2003) Elective lumbar spinal decompression in the elderly: is it a high-risk operation? Can J Surg 46:43–46

    PubMed  PubMed Central  Google Scholar 

  27. Balabaud L, Pitel S, Caux I et al (2015) Lumbar spine surgery in patients 80 years of age or older: morbidity and mortality. Eur J Orthop Surg Traumatol 25(Suppl 1):S205–S212. https://doi.org/10.1007/s00590-014-1556-3

    Article  PubMed  Google Scholar 

  28. Reponen E, Tuominen H, Korja M (2014) Evidence for the use of preoperative risk assessment scores in elective cranial neurosurgery: a systematic review of the literature. Anesth Analg 119(2):420–432. https://doi.org/10.1213/ANE.0000000000000234

    Article  PubMed  Google Scholar 

  29. Ius T, Somma T, Altieri R et al (2020) Is age an additional factor in the treatment of elderly patients with glioblastoma? A new stratification model: an Italian Multicenter Study. Neurosurg Focus 49(4):E13. https://doi.org/10.3171/2020.7.FOCUS20420

    Article  PubMed  Google Scholar 

  30. Evers PD, Logan JE, Sills V, Chin AI (2014) Karnofsky performance status predicts overall survival, cancer-specific survival, and progression-free survival following radical cystectomy for urothelial carcinoma. World J Urol 32(2):385–391. https://doi.org/10.1007/s00345-013-1110-7

    Article  PubMed  Google Scholar 

  31. Rades D, Conde AJ, Garcia R et al (2015) A new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from breast cancer. Radiat Oncol 10:173. https://doi.org/10.1186/s13014-015-0483-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Tabouret E, Gravis G, Cauvin C, Loundou A, Adetchessi T, Fuentes S (2015) Long-term survivors after surgical management of metastatic spinal cord compression. Eur Spine J 24(1):209–215. https://doi.org/10.1007/s00586-014-3676-1

    Article  PubMed  Google Scholar 

  33. Gao X, Wu Z, Wang T et al (2023) A discussion on the Criteria for Surgical decision-making in Elderly patients with metastatic spinal cord Compression. Global Spine J 13(1):45–52. https://doi.org/10.1177/2192568221991107

    Article  PubMed  Google Scholar 

  34. Barzilai O, Versteeg AL, Goodwin CR et al (2019) Association of neurologic deficits with surgical outcomes and health-related quality of life after treatment for metastatic epidural spinal cord compression. Cancer 125(23):4224–4231. https://doi.org/10.1002/cncr.32420

    Article  PubMed  Google Scholar 

  35. Kortebein P, Symons TB, Ferrando A et al (2008) Functional impact of 10 days of bed rest in healthy older adults. J Gerontol Biol Sci Med Sci 63(10):1076–1081. https://doi.org/10.1093/gerona/63.10.1076

    Article  Google Scholar 

Download references

Acknowledgements

This study is a prosecution of previous work on the application of the validated NSE score for which the Resident and Fellow Research Award NASS was received in 2022 NASS Congress (Cofano F, Di Perna G, Zenga F, Ducati A, Baldassarre B, Ajello M, Marengo N, Ceroni L, Lanotte M, Garbossa D. The Neurology-Stability-Epidural compression assessment: A new score to establish the need for surgery in spinal metastases. Clin Neurol Neurosurg. 2020 Aug;195:105896. https://doi.org/10.1016/j.clineuro.2020.105896. Epub 2020 May 19. Erratum in: Clin Neurol Neurosurg. 2021 May 8;205:106673. PMID: 32526620.)

Funding

This study was not received any funding.

Author information

Authors and Affiliations

Authors

Contributions

G.D.P. writing, methodology, editing, conceptualization; B.B. editing, analysis; R.D.M., editing, analysis, visualization; D.A., A. Pesa. and A. Pesc. analysis; M.B., S.P., L.B., E.D.L., D.O., C.S., N.M., M.A., F.T., F.Z., M.L., A.Po., A.F., R.A., F.Ce., G.M.B., U.R., editing, data curation and investigation; S.B. data curation; D.G. methodology; F.Co. writing, conceptualization, methodology, supervision and coordination of the study group.

Corresponding author

Correspondence to Raffaele De Marco.

Ethics declarations

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 animals performed by any of the authors.

Conflict of interest

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We wish to draw the attention of the Editor to the following facts which may be considered as potential conflicts of interest and to significant financial contributions to this work.

Informed consent

Informed consent was obtained from all individual participants included in the study. No patients under the Age 18 were included. Any potentially identifiable images or data included in this article The patient has consented to the submission of this review article to the journal. Written consent for publication was obtained from all patients.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property.

We further confirm that any aspect of the work covered in this manuscript that has involved either experimental animals or human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript.

We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He/she is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Perna, G., Baldassarre, B., Armocida, D. et al. Application of the NSE score (Neurology-Stability-Epidural compression assessment) to establish the need for surgery in spinal metastases of elderly patients: a multicenter investigation. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08328-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00586-024-08328-0

Keywords

Navigation