Nicolas Dea

Study Design.: Retrospective analysis of a multicenter, prospective observational cohort. Objective.: To identify distinct postoperative trajectories of mental health following surgery for degenerative cervical myelopathy (DCM) and to assess the independent association between trajectory membership and 12-month patient satisfaction. Summary of Background Data.: Although surgery improves neurological and functional outcomes for patients with DCM, its impact on mental health remains poorly characterized. Patients with DCM frequently report poor mental well-being, which may influence quality of life and satisfaction with treatment. Methods.: We analyzed data from the ongoing Canadian Spine Outcomes Research Network (CSORN) multicenter prospective observational DCM study. Group-based trajectory modeling (GBTM) was used to identify latent MCS recovery trajectories. Logistic regression evaluated associations between trajectory group membership and 12-month satisfaction, adjusting for demographic and clinical variables. Results.: Among the 729 patients included, four distinct trajectories of mental health HRQoL recovery were identified based on longitudinal MCS scores: Low-stable (persistently low MCS [12%]), Moderate-stable (intermediate and unchanged MCS [36%]), Good-stable (high and stable MCS [38%]), and Improved (low baseline MCS with postoperative improvement [14%]). Pairwise comparisons showed that the Improved group achieved significantly greater gains in disability (NDI, P P =0.002), mental health HRQoL (MCS, P P =0.001) compared with the Low-stable group, while changes in neurologic function and arm pain did not differ. Trajectory group membership was associated with satisfaction: compared with Low-stable, Good-stable (OR 7.39, 95% CI 3.09–17.70) and Improved (OR 4.18, 95% CI 1.77–9.87) groups were significantly more likely to report being satisfied at 12 months. Conclusion.: Mental health HRQoL recovery following DCM surgery is heterogeneous, with only a minority of patients achieving substantial postoperative improvement. Whether routine assessment of mental-health HRQoL or targeted perioperative support alters outcomes is an area of research that warrants prospective study.

Study design.: Prospective cohort study Objective.: Our primary objective was to determine the effects of all classes of obesity (BMI ≥30) on patient-reported disability at one year of follow-up among patients undergoing surgery for degenerative lumbar conditions, with particular attention given to the effects of severe obesity (BMI ≥40). Secondary objectives were to determine effects on health-related quality of life, back pain, leg pain, and adverse events. Summary of Background Data.: The importance of obesity among patients undergoing spine surgery has been well-established, but effects according to severity of obesity remain poorly understood. Methods.: Patients were prospectively enrolled in the Canadian Spine Outcomes and Research Network between 2015 and 2024. We used logistic regression and propensity score matching to compare outcomes while adjusting for potential confounders. Results.: Among 6,242 patients, 2309 (37%) had obesity including 1448 (23%) with Class I (BMI 30 to P P P P <0.01) were all significantly higher among patients with Class III obesity. Conclusions.: Patients with obesity were less likely to experience improvement of disability after surgery for degenerative lumbar conditions and severe obesity was particularly associated with greater odds adverse events. These findings inform shared clinical decision-making and suggest that obesity management prior to surgery may be of benefit.

Specialized acute and rehabilitation care for traumatic spinal cord injury aims to improve outcomes. This study assessed whether receiving specialized acut

Vertebral metastatic disease results from many types of cancer and can have a devastating impact on patient mobility, psychological health, quality of life, and ultimately overall patient survival. However, the development of radiotherapy and surgical techniques has rapidly surged in conjunction with ongoing advances in basic science and translational studies. In this review, we discuss the paradigm shift in our understanding of the epidemiology and treatment algorithms for spinal oncology, ranging from preoperative optimization strategies, radiation and surgical techniques, the utilization of molecular markers and targeted therapeutics in medical oncology, and prognostication tools that underscore a new multidisciplinary approach to spinal oncology care.

Background: The hemodynamic management of acute spinal cord injury (SCI) aims to improve perfusion and mitigate ischemic secondary injury to the injured spinal cord, traditionally through the augmentation of mean arterial pressure (MAP). Recently, there has been interest in managing spinal cord perfusion pressure (SCPP)—the difference between MAP and intrathecal pressure (ITP) —after acute SCI. SCPP may be more physiologically relevant than MAP for neurologic recovery after traumatic SCI. Drainage of cerebrospinal fluid (CSF) through a lumbar intrathecal catheter to reduce ITP and increase SCPP is commonly performed to reduce the risk of ischemic paralysis in thoracoabdominal aortic aneurysm (TAAA) surgery. We investigated a protocol for CSF drainage through intrathecal catheters to maintain SCPP ≥65 mmHg in participants with acute traumatic SCI. We sought to determine if managing SCPP was associated with better neurologic recovery compared to traditional MAP targets. Methods and findings: Fifty-eight participants with acute SCI (51 ± 19 years, 46M/12F) were enrolled across eight North American sites between August 2019 and May 2024 into this prospective single-arm multi-center clinical trial of CSF drainage for SCPP management ( NCT03911492 ). Data were compared to data from a historical cohort of 86 participants (44 ± 19 years, 72M/14F) who had intrathecal catheters inserted for SCPP measurement only; these participants were managed according to conventional MAP guidelines with a target MAP of 85–90 mmHg (NCT01279811). MAP, ITP, SCPP, intrathecal waveform morphology, vasopressor use, and CSF drainage volume were reported for up to 7 days following SCI. Fifteen participants in the intervention group were lost to follow-up. Neurological assessments at enrollment and 6-months post-SCI were compared. The investigator team ended the trial when it was clear that adherence to the protocol was inconsistent across study sites. Participants managed according to the SCPP management protocol had an intrathecal catheter in place 138 hours (95% CI [129,147]) and 495cc (95% CI [350,641]) of CSF drained. No CSF was drained from seven participants. There were no significant differences in hemodynamic measures such as ITP and SCPP between groups, indicating that the SCPP management protocol did not alter the hemodynamic management. Subsequently, there were no differences in measures of neurological recovery between participants managed according to SCPP management protocol and conventional MAP guidelines ( p = 0.897). Participants managed according to an SCPP target had more ITP waveform recordings noted as dampened or fully pulsatile suggesting a patent subarachnoid space (p = 0.006) and were administered vasopressors on fewer hourly observations (p = 0.004). Six reported adverse events were probably related to the intervention. Adherence to a protocol for managing SCPP through CSF drainage across multiple sites was challenging. Conclusions: Ultimately, our protocol resulted in little CSF being drained, limited modification of ITP and SCPP, and no effect on neurological recovery. The relationship between CSF drainage volume and change in ITP was surprisingly unclear. This study revealed that draining CSF is more complex in traumatic SCI than in TAAA surgery patients. Future efforts to reduce ITP through CSF drainage likely need to address the occlusion of the subarachnoid space at the injury site through aggressive surgical decompression techniques.

OBJECTIVE: Chordomas are rare, locally aggressive primary neoplasms. Resection with negative margins is the primary recommended therapeutic approach, while adjuvant radiotherapy and chemotherapy can also play a role in their treatment in certain situations, including lesions with positive margins or those that are poorly differentiated or dedifferentiated. Cervical spine chordomas pose significant surgical challenges given their proximity to critical anatomical structures and the mechanical constraints of the cervical spine. In the current case series, authors aimed to explore the clinical and patient-reported outcomes (PROs) of the surgical treatment of cervical chordomas in a large multicenter cohort. METHODS: This multicenter case series analysis utilized data from the prospectively collected Primary Tumor Research and Outcomes Network (PTRON) registry, from its inception (May 16, 2016) to data extraction (February 29, 2024). The study population was restricted to patients with histologically confirmed cervical chordomas involving levels C0–7, who underwent surgical treatment at one of the participating centers, and for whom both the initially planned and postoperatively pathologically confirmed surgical margins were documented. Patient demographics, tumor characteristics, surgical and adjuvant treatments, local recurrence–free survival (LRFS), overall survival (OS), and perioperative adverse events were retrieved. PROs included the Spine Oncology Study Group Outcomes Questionnaire version 2.0 (SOSGOQ2.0), EQ-5D, and SF-36 version 2.0 (SF-36v2). RESULTS: Thirty-eight patients were identified, 12 of whom underwent true en bloc resection (EBR), 18 of whom underwent deliberate intralesional resection, and 8 of whom underwent EBR after intralesional surgery or in whom EBR failed. True EBR led to better LRFS (92% vs 83% vs 63%, respectively) and OS (83% vs 39% vs 50%, respectively). Surgical adverse events within 1 year were more frequent with true EBR (100% vs 39% vs 75%, respectively). EQ-5D, SOSGOQ2.0, and SF-36v2 showed improvement with true EBR, whereas the trends for PROs from the other groups were more variable. CONCLUSIONS: This multicenter case series analysis provides critical insights into the clinical outcomes and PROs in the largest cohort of surgically treated cervical spine chordomas described to date. It underscores the importance and challenges of wide resection for oncological control. It establishes the associated morbidity and provides an overview of PROs following surgery. These findings contribute valuable evidence to inform shared decision-making and optimize patient care.

Background: This study reports the development and validation of the Home time and Overall survival after Metastatic spine tumor surgery Estimator (HOME score). Methods: A population cohort study was conducted, including 2348 adults with spine metastases treated with surgery in the 2005 to 2020 Ontario Cancer registry. HOME score predictions were the likelihood of post-surgery home time of 3-months or less, and overall survival at 6 months, 1 year, and 1.5 years after surgery. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) for home time predictions, and the concordance index (C-index) for survival. Variable importance was quantified using standardized coefficients. Results: Mean age was 62.4 years (SD: 12.6) and the most common primary cancer was lung (N = 513, 21.9%). Patients treated between 2005 and 2018 were allocated to training, and those treated in 2019-2020 were used as a hold-out test cohort. The final model included 17 items for home time prediction, and 24 items for survival prediction including demographic, comorbid, cancer, and presentation features. Performance of the home time model (AUC: 0.70), and survival model (C-index 0.70, 6-month AUC: 0.73, 1-year AUC: 0.75, 1.5-year AUC: 0.76) was stable across training and testing. Primary cancer origin and history of congestive heart failure (CHF) ranked highest among features impacting outcome predictions. Conclusions: The HOME score (https://shakilh.shinyapps.io/home_app/) accurately predicts home time and survival for patients with spinal metastases undergoing surgery. Key factors influencing predictions were primary origin, and history of CHF. This represents a significant advancement to patient centered preoperative risk stratification.

Study Design.: Delphi consensus. Objective.: To define an optimal surgical composite outcome measure in patients with metastatic spine disease (OSCO-M) through international consensus among key opinion leaders. Materials and Methods.: Members of the AO Spine Knowledge Forum Tumor, an international group of dedicated spine oncology surgeons and oncologists, participated in a modified Delphi process between March 2023 and November 2024. The study was conducted in 2 parts. The first part aimed on identifying which outcome variables were deemed important to be included in the composite outcome. The second part focused on the definition of a successful outcome with regards to the agreed variables from Part 1. Each part consisted of a questionnaire and a consensus meeting. Consensus was achieved when a threshold of 70% agreement was reached. Results.: A total of 42 dedicated spine oncology surgeons and oncologists from North America, Latin America, Europe, and Asia participated. Over 87% of respondents agreed that composite measures reflect the multidimensional aspect of the surgical process more than an individual outcome variable. Most respondents (93%) agreed/strongly agreed that composite measures should be used to assess the quality of surgical care in spine oncology. Through consensus, the following three outcome variables were selected to define the OSCO-M: the absence of SAVES-V2 (Spinal Adverse Events Severity System, Version 2) grade 3 adverse events or higher within 30 days of surgery, maintaining or improving ECOG (Eastern Cooperative Oncology Group) performance status at 90 days, and being ambulatory (with or without aid) at 90 days. Conclusion.: This is the first study defining a composite outcome measure in oncologic surgery for spinal metastases derived from an international group of key opinion leaders in spine oncology. The OSCO-M may be useful for future research in spine tumor patients and serve as a benchmark to optimize outcomes.

BACKGROUND AND OBJECTIVES: The Patient-Generated Subjective Global Assessment (PG-SGA) is a standardized tool for assessing malnutrition in patients with cancer. The primary aim of this study was to assess the impact of preoperative nutritional status as measured by PG-SGA on survival in patients requiring surgical intervention and/or radiotherapy for spinal metastases. METHODS: Patients with spinal metastases who underwent surgery and/or radiation therapy for symptomatic spinal metastases were enrolled in the AO Spine Metastatic Tumor Research and Outcomes Network, a prospective international multicenter research registry, between September 2017 and August 2022. Using the PG-SGA, nutritional status was classified into 3 categories: A, well nourished; B, moderately malnourished; and C, severely malnourished. RESULTS: A total of 589 patients met the inclusion criteria; 362 were classified as well nourished (61%), 159 were moderately malnourished (27%), and 68 were severely malnourished (12%). The median survival was 491 days, 328 days, and 117 days for well-nourished, moderately malnourished, and severely malnourished patients, respectively. In the multivariate analyses, severe malnourishment (HR 2.5 95% CI 1.4-4.3, P < .01) and an ECOG performance status of 3 or 4 (HR 2.7 95% CI 1.2-6.0) remained associated with significantly worse survival. CONCLUSION: Malnutrition as measured by the PG-SGA demonstrated to be significantly and independently associated with postoperative survival. The PG-SGA is a simple and useful tool to identify spinal metastases patients at risk of early postoperative mortality, and inclusion in the preoperative evaluation of these patients should be considered.