Spinal metastases and metastatic spinal cord compression: interpretation for National Institute for Health and Care Excellence (NICE) 2023 guideline_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jie ^1,2 ,  CHEN Lei ^1,2 , HU Lundeng ^1,2 , LIN Jianhua ^1,2

1. Department of Orthopedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou Fujian, 350005, P. R. China;
2. Department of Orthopedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou Fujian, 350212, P. R. China;

Corresponding author：

CHEN Lei, Email: fjydgk@126.com

Keywords：

Spinal metastases; metastatic spinal cord compression; guidelines

DOI：

10.7507/1002-1892.202404108

Video：

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Spine is a common site of metastasis in patients with malignant tumors, and tumor metastasis to the spine can lead to pain, pathological fractures, and nerve compression. In order to optimize the diagnosis and management of patients with spinal metastases and metastatic spinal cord compression (MSCC), the National Institute for Health and Care Excellence (NICE) in the UK proposed the first diagnostic and treatment guidelines for patients with MSCC (or at risk of MSCC) in 2008. In recent years, with the rapid advancement of spinal surgery and radiotherapy technology, the standardized process of MSCC diagnosis and treatment urgently needs to be updated. In 2023, NICE launched new guidelines for spinal metastases and MSCC. Based on a thorough study of the guidelines, this article discusses and interprets pain management, corticosteroid treatment, application of bisphosphonates and denosumab, tools for assessing spinal stability and prognosis, radiation therapy, surgical timing and approach, etc., providing reference for clinical diagnosis and treatment in China.

Citation： LI Jie, CHEN Lei, HU Lundeng, LIN Jianhua. Spinal metastases and metastatic spinal cord compression: interpretation for National Institute for Health and Care Excellence (NICE) 2023 guideline. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1035-1039. doi: 10.7507/1002-1892.202404108 Copy

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2.	Barzilai O, McLaughlin L, Amato MK, et al. Predictors of quality of life improvement after surgery for metastatic tumors of the spine: prospective cohort study. Spine J, 2018, 18(7): 1109-1115.
3.	Moussazadeh N, Laufer I, Yamada Y, et al. Separation surgery for spinal metastases: effect of spinal radiosurgery on surgical treatment goals. Cancer Control, 2014, 21(2): 168-174.
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5.	National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression: NICE guideline draft [S/OL]. 2023-09-06 [2024-07-29]. https://www.nice.org.uk/guidance/ng234/documents/draft-guideline.
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7.	Kurisunkal V, Gulia A, Gupta S. Principles of management of spine metastasis. Indian J Orthop, 2020, 54(2): 181-193.
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9.	Coleman R, Hadji P, Body JJ, et al. Bone health in cancer: ESMO Clinical Practice Guidelines. Ann Oncol, 2020, 31(12): 1650-1663.
10.	Stopeck A, de Boer R, Fujiwara Y et al. A comparison of denosumab versus zoledronic acid for the prevention of skeletal-related events in breast cancer patients with bone metastases. Cancer Res, 2009, 69(24): 490S. doi: https://doi.org/10.1158/0008-5472.SABCS-09-22.
11.	Fizazi K, Lipton A, Mariette X, et al. Randomized phase Ⅱ trial of denosumab in patients with bone metastases from prostate cancer, breast cancer, or other neoplasms after intravenous bisphosphonates. J Clin Oncol, 2009, 27(10): 1564-1571.
12.	Adamietz IA, Feyer P. Palliative radiotherapie//Bamberg M, Molls M, Sack H. Radioonkologie. München: Zuckschwerdt, 2009: 1065-1106.
13.	Rades D, Stalpers LJ, Veninga T, et al. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol, 2005, 23(15): 3366-3375.
14.	Gezercan Y, Çavuş G, Ökten AI, et al. Single-stage posterolateral transpedicular approach with 360-degree stabilization and vertebrectomy in primary and metastatic tumors of the spine. World Neurosurg, 2016, 95: 214-221.
15.	Oka S, Matsumiya H, Shinohara S, et al. Total or partial vertebrectomy for lung cancer invading the spine. Ann Med Surg (Lond), 2016, 12: 1-4.
16.	梁运, 刘鹏, 周晓岗, 等. 一期后路全脊椎切除术治疗多椎节脊柱肿瘤. 中国脊柱脊髓杂志, 2017, 27(9): 781-786.
17.	杨立, 伦登兴 , 张浩, 等. 脊柱转移瘤全脊椎切除术的临床疗效分析. 中国脊柱脊髓杂志, 2017, 27(9): 772-780.
18.	王志龙, 林文俐, 梁逸宁, 等. 微波消融联合椎体成形术治疗脊柱转移瘤研究进展. 介入放射学杂志, 2023, 32(4): 404-409.

1. Barzilai O, Laufer I, Yamada Y, et al. Integrating evidence-based medicine for treatment of spinal metastases into a decision framework: neurologic, oncologic, mechanicals stability, and systemic disease. J Clin Oncol, 2017, 35(21): 2419-2427.
2. Barzilai O, McLaughlin L, Amato MK, et al. Predictors of quality of life improvement after surgery for metastatic tumors of the spine: prospective cohort study. Spine J, 2018, 18(7): 1109-1115.
3. Moussazadeh N, Laufer I, Yamada Y, et al. Separation surgery for spinal metastases: effect of spinal radiosurgery on surgical treatment goals. Cancer Control, 2014, 21(2): 168-174.
4. Witham TF, Khavkin YA, Gallia GL, et al. Surgery insight: current management of epidural spinal cord compression from metastatic spine disease. Nat Clin Pract Neurol, 2006, 2(2): 87-94, 116.
5. National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression: NICE guideline draft [S/OL]. 2023-09-06 [2024-07-29]. https://www.nice.org.uk/guidance/ng234/documents/draft-guideline.
6. 中华医学会骨科学分会骨肿瘤学组. 脊柱转移瘤外科治疗指南. 中华骨科杂志, 2019, 39(12): 717-726.
7. Kurisunkal V, Gulia A, Gupta S. Principles of management of spine metastasis. Indian J Orthop, 2020, 54(2): 181-193.
8. 北京医学奖励基金会肺癌青年专家委员会, 中国胸外科肺癌联盟. 肺癌骨转移诊疗专家共识 (2019版). 中国肺癌杂志, 2019, 22(4): 187-207.
9. Coleman R, Hadji P, Body JJ, et al. Bone health in cancer: ESMO Clinical Practice Guidelines. Ann Oncol, 2020, 31(12): 1650-1663.
10. Stopeck A, de Boer R, Fujiwara Y et al. A comparison of denosumab versus zoledronic acid for the prevention of skeletal-related events in breast cancer patients with bone metastases. Cancer Res, 2009, 69(24): 490S. doi: https://doi.org/10.1158/0008-5472.SABCS-09-22.
11. Fizazi K, Lipton A, Mariette X, et al. Randomized phase Ⅱ trial of denosumab in patients with bone metastases from prostate cancer, breast cancer, or other neoplasms after intravenous bisphosphonates. J Clin Oncol, 2009, 27(10): 1564-1571.
12. Adamietz IA, Feyer P. Palliative radiotherapie//Bamberg M, Molls M, Sack H. Radioonkologie. München: Zuckschwerdt, 2009: 1065-1106.
13. Rades D, Stalpers LJ, Veninga T, et al. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol, 2005, 23(15): 3366-3375.
14. Gezercan Y, Çavuş G, Ökten AI, et al. Single-stage posterolateral transpedicular approach with 360-degree stabilization and vertebrectomy in primary and metastatic tumors of the spine. World Neurosurg, 2016, 95: 214-221.
15. Oka S, Matsumiya H, Shinohara S, et al. Total or partial vertebrectomy for lung cancer invading the spine. Ann Med Surg (Lond), 2016, 12: 1-4.
16. 梁运, 刘鹏, 周晓岗, 等. 一期后路全脊椎切除术治疗多椎节脊柱肿瘤. 中国脊柱脊髓杂志, 2017, 27(9): 781-786.
17. 杨立, 伦登兴 , 张浩, 等. 脊柱转移瘤全脊椎切除术的临床疗效分析. 中国脊柱脊髓杂志, 2017, 27(9): 772-780.
18. 王志龙, 林文俐, 梁逸宁, 等. 微波消融联合椎体成形术治疗脊柱转移瘤研究进展. 介入放射学杂志, 2023, 32(4): 404-409.

Chinese Journal of Reparative and Reconstructive Surgery

Spinal metastases and metastatic spinal cord compression: interpretation for National Institute for Health and Care Excellence (NICE) 2023 guideline

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