Treatment Strategy for Impending Instability in Spinal Metastases
Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score (SINS) system is a reliable tool to evaluate instability in spinal metastases. The intermediate SINS (scores 7-12) indicates impending instability...
Gespeichert in:
| Veröffentlicht in: | Clinics in orthopedic surgery Jg. 12; H. 3; S. 337 - 342 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Korea (South)
The Korean Orthopaedic Association
01.09.2020
대한정형외과학회 |
| Schlagworte: | |
| ISSN: | 2005-291X, 2005-4408, 2005-4408 |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| Abstract | Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score (SINS) system is a reliable tool to evaluate instability in spinal metastases. The intermediate SINS (scores 7-12) indicates impending instability, which makes it difficult to determine the proper treatment strategy. In this study, we aimed to compare the initial status and treatment outcomes of a conservative group versus an operative group among patients with spinal metastases with an intermediate SINS of 7-12. Further, we evaluated the time for conversion to surgery in patients who had initially undergone conservative treatment and identified the factors associated with the conversion.
Among the patients with a spinal metastasis with an intermediate SINS of 7-12 from May 2013 to December 2017, those who were followed up for more than 12 months were enrolled in this study. Patients with signs of a neurologic deficit or cord compression at the initial diagnosis were excluded. Finally, 79 patients (47 in the initially conservative group and 32 in the initially operative group) were enrolled in this study. The performance status, Tomita score, and Tokuhashi score were assessed for group comparison. Components of SINS, the Bilsky grade, and radiosensitivity of tumor were evaluated to determine factors associated with conversion to surgery.
Average follow-up was 20.9 months (range, 12-46 months). The demographic variables, primary cancer type, and performance status were not significantly different between the 2 groups. However, the Tomita score was lower in the initially operative group (
= 0.006). The 1-year treatment outcome assessed based on the change in performance status and vertebral height collapse showed a tendency to deteriorate less in the initially operative group. The rate of conversion to surgery in the initially conservative group was 33% in the first year, after which there was little change in the incidence of conversion. When vertebral body collapse was less than 50% or the tumor was located in the semi-rigid region (T3-T10), the need for conversion to surgery increased statistically significantly (
= 0.039 and
= 0.042, respectively).
The rate of conversion to surgery in initially conservatively treated patients was about 33% in the first year. When a tumor is located in T3-T10 and less than 50% vertebral body collapse is present, surgery may be the better choice than conservative treatment. |
|---|---|
| AbstractList | Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score (SINS) system is a reliable tool to evaluate instability in spinal metastases. The intermediate SINS (scores 7-12) indicates impending instability, which makes it difficult to determine the proper treatment strategy. In this study, we aimed to compare the initial status and treatment outcomes of a conservative group versus an operative group among patients with spinal metastases with an intermediate SINS of 7-12. Further, we evaluated the time for conversion to surgery in patients who had initially undergone conservative treatment and identified the factors associated with the conversion.
Among the patients with a spinal metastasis with an intermediate SINS of 7-12 from May 2013 to December 2017, those who were followed up for more than 12 months were enrolled in this study. Patients with signs of a neurologic deficit or cord compression at the initial diagnosis were excluded. Finally, 79 patients (47 in the initially conservative group and 32 in the initially operative group) were enrolled in this study. The performance status, Tomita score, and Tokuhashi score were assessed for group comparison. Components of SINS, the Bilsky grade, and radiosensitivity of tumor were evaluated to determine factors associated with conversion to surgery.
Average follow-up was 20.9 months (range, 12-46 months). The demographic variables, primary cancer type, and performance status were not significantly different between the 2 groups. However, the Tomita score was lower in the initially operative group (
= 0.006). The 1-year treatment outcome assessed based on the change in performance status and vertebral height collapse showed a tendency to deteriorate less in the initially operative group. The rate of conversion to surgery in the initially conservative group was 33% in the first year, after which there was little change in the incidence of conversion. When vertebral body collapse was less than 50% or the tumor was located in the semi-rigid region (T3-T10), the need for conversion to surgery increased statistically significantly (
= 0.039 and
= 0.042, respectively).
The rate of conversion to surgery in initially conservatively treated patients was about 33% in the first year. When a tumor is located in T3-T10 and less than 50% vertebral body collapse is present, surgery may be the better choice than conservative treatment. Background: Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score (SINS) system is a reliable tool to evaluate instability in spinal metastases. The intermediate SINS (scores 7–12) indicates impending instability, which makes it difficult to determine the proper treatment strategy. In this study, we aimed to compare the initial status and treatment outcomes of a conservative group versus an operative group among patients with spinal metastases with an intermediate SINS of 7–12. Further, we evaluated the time for conversion to surgery in patients who had initially undergone conservative treatment and identified the factors associated with the conversion. Methods: Among the patients with a spinal metastasis with an intermediate SINS of 7–12 from May 2013 to December 2017, those who were followed up for more than 12 months were enrolled in this study. Patients with signs of a neurologic deficit or cord compression at the initial diagnosis were excluded. Finally, 79 patients (47 in the initially conservative group and 32 in the initially operative group) were enrolled in this study. The performance status, Tomita score, and Tokuhashi score were assessed for group comparison. Components of SINS, the Bilsky grade, and radiosensitivity of tumor were evaluated to determine factors associated with conversion to surgery. Results: Average follow-up was 20.9 months (range, 12–46 months). The demographic variables, primary cancer type, and performance status were not significantly different between the 2 groups. However, the Tomita score was lower in the initially operative group (p = 0.006). The 1-year treatment outcome assessed based on the change in performance status and vertebral height collapse showed a tendency to deteriorate less in the initially operative group. The rate of conversion to surgery in the initially conservative group was 33% in the first year, after which there was little change in the incidence of conversion. When vertebral body collapse was less than 50% or the tumor was located in the semi-rigid region (T3–T10), the need for conversion to surgery increased statistically significantly (p = 0.039 and p = 0.042, respectively). Conclusions: The rate of conversion to surgery in initially conservatively treated patients was about 33% in the first year. When a tumor is located in T3–T10 and less than 50% vertebral body collapse is present, surgery may be the better choice than conservative treatment. KCI Citation Count: 0 Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score (SINS) system is a reliable tool to evaluate instability in spinal metastases. The intermediate SINS (scores 7-12) indicates impending instability, which makes it difficult to determine the proper treatment strategy. In this study, we aimed to compare the initial status and treatment outcomes of a conservative group versus an operative group among patients with spinal metastases with an intermediate SINS of 7-12. Further, we evaluated the time for conversion to surgery in patients who had initially undergone conservative treatment and identified the factors associated with the conversion.BACKGROUDDetermining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score (SINS) system is a reliable tool to evaluate instability in spinal metastases. The intermediate SINS (scores 7-12) indicates impending instability, which makes it difficult to determine the proper treatment strategy. In this study, we aimed to compare the initial status and treatment outcomes of a conservative group versus an operative group among patients with spinal metastases with an intermediate SINS of 7-12. Further, we evaluated the time for conversion to surgery in patients who had initially undergone conservative treatment and identified the factors associated with the conversion.Among the patients with a spinal metastasis with an intermediate SINS of 7-12 from May 2013 to December 2017, those who were followed up for more than 12 months were enrolled in this study. Patients with signs of a neurologic deficit or cord compression at the initial diagnosis were excluded. Finally, 79 patients (47 in the initially conservative group and 32 in the initially operative group) were enrolled in this study. The performance status, Tomita score, and Tokuhashi score were assessed for group comparison. Components of SINS, the Bilsky grade, and radiosensitivity of tumor were evaluated to determine factors associated with conversion to surgery.METHODSAmong the patients with a spinal metastasis with an intermediate SINS of 7-12 from May 2013 to December 2017, those who were followed up for more than 12 months were enrolled in this study. Patients with signs of a neurologic deficit or cord compression at the initial diagnosis were excluded. Finally, 79 patients (47 in the initially conservative group and 32 in the initially operative group) were enrolled in this study. The performance status, Tomita score, and Tokuhashi score were assessed for group comparison. Components of SINS, the Bilsky grade, and radiosensitivity of tumor were evaluated to determine factors associated with conversion to surgery.Average follow-up was 20.9 months (range, 12-46 months). The demographic variables, primary cancer type, and performance status were not significantly different between the 2 groups. However, the Tomita score was lower in the initially operative group (p = 0.006). The 1-year treatment outcome assessed based on the change in performance status and vertebral height collapse showed a tendency to deteriorate less in the initially operative group. The rate of conversion to surgery in the initially conservative group was 33% in the first year, after which there was little change in the incidence of conversion. When vertebral body collapse was less than 50% or the tumor was located in the semi-rigid region (T3-T10), the need for conversion to surgery increased statistically significantly (p = 0.039 and p = 0.042, respectively).RESULTSAverage follow-up was 20.9 months (range, 12-46 months). The demographic variables, primary cancer type, and performance status were not significantly different between the 2 groups. However, the Tomita score was lower in the initially operative group (p = 0.006). The 1-year treatment outcome assessed based on the change in performance status and vertebral height collapse showed a tendency to deteriorate less in the initially operative group. The rate of conversion to surgery in the initially conservative group was 33% in the first year, after which there was little change in the incidence of conversion. When vertebral body collapse was less than 50% or the tumor was located in the semi-rigid region (T3-T10), the need for conversion to surgery increased statistically significantly (p = 0.039 and p = 0.042, respectively).The rate of conversion to surgery in initially conservatively treated patients was about 33% in the first year. When a tumor is located in T3-T10 and less than 50% vertebral body collapse is present, surgery may be the better choice than conservative treatment.CONCLUSIONSThe rate of conversion to surgery in initially conservatively treated patients was about 33% in the first year. When a tumor is located in T3-T10 and less than 50% vertebral body collapse is present, surgery may be the better choice than conservative treatment. |
| Author | Kim, Yeon Ho Kim, Hyoungmin Kim, Junho Chang, Sam Yeol Chang, Bong-Soon |
| AuthorAffiliation | Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea |
| AuthorAffiliation_xml | – name: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea |
| Author_xml | – sequence: 1 givenname: Yeon Ho surname: Kim fullname: Kim, Yeon Ho organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea – sequence: 2 givenname: Junho surname: Kim fullname: Kim, Junho organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea – sequence: 3 givenname: Sam Yeol surname: Chang fullname: Chang, Sam Yeol organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea – sequence: 4 givenname: Hyoungmin surname: Kim fullname: Kim, Hyoungmin organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea – sequence: 5 givenname: Bong-Soon surname: Chang fullname: Chang, Bong-Soon organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32904056$$D View this record in MEDLINE/PubMed https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002621002$$DAccess content in National Research Foundation of Korea (NRF) |
| BookMark | eNptkclOwzAQhi0EYj_wAihHOBTs2HGSC1JVsVQqQoIicbMcZ1IMiV1sF6lvj1tKWYR8GC_f_8-MZw9tGmsAoSOCzxjOsnOlrU8xJmwD7caY9RjDxeZqn5bkaQftef-CMc94jrfRDk1LHJV8F_XHDmTowITkITgZYDJPGuuSYTcFU2szSYbGB1npVod5ok3yMNVGtsktBBnvPfgDtNXI1sPhKu6jx6vL8eCmN7q7Hg76o55iuAw9KqHIUlpTVUrOgVU0JbSEumKEgIwLN4sjYSmnVU2gKEBxRitWK1KqDOg-Ov30Na4Rr0oLK_UyTqx4daJ_Px6KMs9jh0VkLz7Z6azqoFaxPSdbMXW6k26-VP5-Mfo5-ryLnLGyyPJocLIycPZtBj6ITnsFbSsN2JkXKWOEY0Y5jejxz1zrJF9__F24ctZ7B80aIVgs5ifW84vs-R9W6SCDtosydfuP4gOySJ5K |
| CitedBy_id | crossref_primary_10_1186_s12885_023_11495_w crossref_primary_10_1016_j_wneu_2024_123627 crossref_primary_10_31616_asj_2022_0367 crossref_primary_10_1177_21925682251359292 crossref_primary_10_3390_jpm11020110 crossref_primary_10_1177_21925682231220551 crossref_primary_10_31616_asj_2025_0078 crossref_primary_10_1016_j_jacr_2024_08_016 crossref_primary_10_3390_jcm13247860 crossref_primary_10_3390_cancers17091539 crossref_primary_10_1016_j_wneu_2024_06_159 crossref_primary_10_1007_s00586_023_07987_9 crossref_primary_10_3390_cancers16142554 crossref_primary_10_1136_spcare_2023_004537 crossref_primary_10_3390_cancers14092193 crossref_primary_10_1177_21925682211033591 |
| Cites_doi | 10.1016/j.ijrobp.2017.08.028 10.1097/00007632-199702010-00002 10.1016/j.spinee.2013.08.044 10.1016/j.semradonc.2017.03.004 10.1097/00007632-198803000-00006 10.1016/j.spinee.2015.10.006 10.1503/cjs.012013 10.1007/s00586-016-4921-6 10.1634/theoncologist.2012-0293 10.1007/s11060-015-1794-1 10.31616/asj.2019.0203 10.1186/1748-717X-9-69 10.1017/S031716710001177X 10.31616/asj.2019.0060 10.1097/BRS.0b013e3181e16ae2 10.3171/2014.9.SPINE14554 10.1007/s00256-018-3032-3 10.1200/JCO.2010.34.3897 10.2106/00004623-198668070-00025 10.1097/00007632-199806010-00006 |
| ContentType | Journal Article |
| Copyright | Copyright © 2020 by The Korean Orthopaedic Association. Copyright © 2020 by The Korean Orthopaedic Association 2020 The Korean Orthopaedic Association |
| Copyright_xml | – notice: Copyright © 2020 by The Korean Orthopaedic Association. – notice: Copyright © 2020 by The Korean Orthopaedic Association 2020 The Korean Orthopaedic Association |
| DBID | AAYXX CITATION CGR CUY CVF ECM EIF NPM 7X8 5PM ACYCR |
| DOI | 10.4055/cios20014 |
| DatabaseName | CrossRef Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic PubMed Central (Full Participant titles) Korean Citation Index |
| DatabaseTitle | CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 2005-4408 |
| EndPage | 342 |
| ExternalDocumentID | oai_kci_go_kr_ARTI_9775678 PMC7449857 32904056 10_4055_cios20014 |
| Genre | Journal Article Comparative Study |
| GroupedDBID | --- 5-W 53G 8JR 8XY AAYXX ADBBV ADRAZ ALMA_UNASSIGNED_HOLDINGS AOIJS BAWUL BCNDV C1A CITATION DIK E3Z EBD EF. EMOBN F5P FRP GROUPED_DOAJ HYE KQ8 M48 O5R O5S OK1 PGMZT RPM SV3 TR2 W2D 9ZL CGR CUY CVF ECM EIF M~E NPM 7X8 5PM ACYCR |
| ID | FETCH-LOGICAL-c409t-3ae8523d3c9a66e4b32139edb411eaeae0f39ed14263bd1e88ec643b4dc19c5e3 |
| ISICitedReferencesCount | 18 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000562890900011&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 2005-291X 2005-4408 |
| IngestDate | Sun Mar 09 07:52:33 EDT 2025 Tue Nov 04 01:58:51 EST 2025 Wed Oct 01 12:02:55 EDT 2025 Thu Jan 02 22:54:42 EST 2025 Sat Nov 29 03:07:31 EST 2025 Tue Nov 18 21:35:51 EST 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 3 |
| Keywords | Spinal metastasis Spinal instability neoplastic score Impending instability Survival curve |
| Language | English |
| License | Copyright © 2020 by The Korean Orthopaedic Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-c409t-3ae8523d3c9a66e4b32139edb411eaeae0f39ed14263bd1e88ec643b4dc19c5e3 |
| Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 https://www.ecios.org/search.php?where=aview&id=10.4055/cios20014&code=0157CIOS&vmode=FULL |
| OpenAccessLink | http://dx.doi.org/10.4055/cios20014 |
| PMID | 32904056 |
| PQID | 2441604363 |
| PQPubID | 23479 |
| PageCount | 6 |
| ParticipantIDs | nrf_kci_oai_kci_go_kr_ARTI_9775678 pubmedcentral_primary_oai_pubmedcentral_nih_gov_7449857 proquest_miscellaneous_2441604363 pubmed_primary_32904056 crossref_primary_10_4055_cios20014 crossref_citationtrail_10_4055_cios20014 |
| PublicationCentury | 2000 |
| PublicationDate | 2020-09-01 |
| PublicationDateYYYYMMDD | 2020-09-01 |
| PublicationDate_xml | – month: 09 year: 2020 text: 2020-09-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | Korea (South) |
| PublicationPlace_xml | – name: Korea (South) |
| PublicationTitle | Clinics in orthopedic surgery |
| PublicationTitleAlternate | Clin Orthop Surg |
| PublicationYear | 2020 |
| Publisher | The Korean Orthopaedic Association 대한정형외과학회 |
| Publisher_xml | – name: The Korean Orthopaedic Association – name: 대한정형외과학회 |
| References | Paton (10.4055/cios20014_ref1) 2011; 38 Ulmar (10.4055/cios20014_ref22) 2007; 30 Windhagen (10.4055/cios20014_ref9) 1997 Aoude (10.4055/cios20014_ref20) 2014; 57 Taneichi (10.4055/cios20014_ref8) 1997; 22 Fourney (10.4055/cios20014_ref16) 2011; 29 Whyne (10.4055/cios20014_ref10) 2003; 28 Katsoulakis (10.4055/cios20014_ref4) 2017; 27 Dimar (10.4055/cios20014_ref11) 1998; 23 Weber (10.4055/cios20014_ref12) 2011; 38 Kostuik (10.4055/cios20014_ref7) 1988; 13 Lee (10.4055/cios20014_ref23) 2015; 123 Leone (10.4055/cios20014_ref17) 2019; 48 Park (10.4055/cios20014_ref19) 2020; 14 Arana (10.4055/cios20014_ref13) 2016; 16 Harrington (10.4055/cios20014_ref6) 1986; 68 Zadnik (10.4055/cios20014_ref18) 2015; 22 Bernard (10.4055/cios20014_ref5) 2017; 99 Laufer (10.4055/cios20014_ref2) 2013; 18 Aoude (10.4055/cios20014_ref21) 2018; 27 Campos (10.4055/cios20014_ref15) 2014; 14 Fisher (10.4055/cios20014_ref14) 2014; 9 Fisher (10.4055/cios20014_ref3) 2010; 35 Tan (10.4055/cios20014_ref24) 2020; 14 |
| References_xml | – volume: 99 start-page: 1207 issue: 5 year: 2017 ident: 10.4055/cios20014_ref5 publication-title: Int J Radiat Oncol Biol Phys doi: 10.1016/j.ijrobp.2017.08.028 – volume: 22 start-page: 239 issue: 3 year: 1997 ident: 10.4055/cios20014_ref8 publication-title: Spine (Phila Pa 1976) doi: 10.1097/00007632-199702010-00002 – volume: 14 start-page: 1466 issue: 8 year: 2014 ident: 10.4055/cios20014_ref15 publication-title: Spine J doi: 10.1016/j.spinee.2013.08.044 – volume: 27 start-page: 209 issue: 3 year: 2017 ident: 10.4055/cios20014_ref4 publication-title: Semin Radiat Oncol doi: 10.1016/j.semradonc.2017.03.004 – volume: 13 start-page: 250 issue: 3 year: 1988 ident: 10.4055/cios20014_ref7 publication-title: Spine (Phila Pa 1976) doi: 10.1097/00007632-198803000-00006 – volume: 16 start-page: 591 issue: 5 year: 2016 ident: 10.4055/cios20014_ref13 publication-title: Spine J doi: 10.1016/j.spinee.2015.10.006 – volume: 57 start-page: 188 issue: 3 year: 2014 ident: 10.4055/cios20014_ref20 publication-title: Can J Surg doi: 10.1503/cjs.012013 – volume: 38 start-page: 5 issue: 1 year: 2011 ident: 10.4055/cios20014_ref12 publication-title: Int J Oncol – volume: 27 start-page: 835 issue: 4 year: 2018 ident: 10.4055/cios20014_ref21 publication-title: Eur Spine J doi: 10.1007/s00586-016-4921-6 – volume: 18 start-page: 744 issue: 6 year: 2013 ident: 10.4055/cios20014_ref2 publication-title: Oncologist doi: 10.1634/theoncologist.2012-0293 – volume: 30 start-page: 414 issue: 8-9 year: 2007 ident: 10.4055/cios20014_ref22 publication-title: Onkologie – volume: 123 start-page: 267 issue: 2 year: 2015 ident: 10.4055/cios20014_ref23 publication-title: J Neurooncol doi: 10.1007/s11060-015-1794-1 – volume: 14 start-page: 388 issue: 3 year: 2020 ident: 10.4055/cios20014_ref24 publication-title: Asian Spine J doi: 10.31616/asj.2019.0203 – volume: 9 start-page: 69 year: 2014 ident: 10.4055/cios20014_ref14 publication-title: Radiat Oncol doi: 10.1186/1748-717X-9-69 – volume: 38 start-page: 396 issue: 3 year: 2011 ident: 10.4055/cios20014_ref1 publication-title: Can J Neurol Sci doi: 10.1017/S031716710001177X – volume: 14 start-page: 192 issue: 2 year: 2020 ident: 10.4055/cios20014_ref19 publication-title: Asian Spine J doi: 10.31616/asj.2019.0060 – volume: 35 start-page: E1221 issue: 22 year: 2010 ident: 10.4055/cios20014_ref3 publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e3181e16ae2 – start-page: 313 issue: 344 year: 1997 ident: 10.4055/cios20014_ref9 publication-title: Clin Orthop Relat Res – volume: 28 start-page: 652 issue: 7 year: 2003 ident: 10.4055/cios20014_ref10 publication-title: Spine (Phila Pa 1976) – volume: 22 start-page: 301 issue: 3 year: 2015 ident: 10.4055/cios20014_ref18 publication-title: J Neurosurg Spine doi: 10.3171/2014.9.SPINE14554 – volume: 48 start-page: 195 issue: 2 year: 2019 ident: 10.4055/cios20014_ref17 publication-title: Skeletal Radiol doi: 10.1007/s00256-018-3032-3 – volume: 29 start-page: 3072 issue: 22 year: 2011 ident: 10.4055/cios20014_ref16 publication-title: J Clin Oncol doi: 10.1200/JCO.2010.34.3897 – volume: 68 start-page: 1110 issue: 7 year: 1986 ident: 10.4055/cios20014_ref6 publication-title: J Bone Joint Surg Am doi: 10.2106/00004623-198668070-00025 – volume: 23 start-page: 1209 issue: 11 year: 1998 ident: 10.4055/cios20014_ref11 publication-title: Spine (Phila Pa 1976) doi: 10.1097/00007632-199806010-00006 |
| SSID | ssj0065670 |
| Score | 2.281601 |
| Snippet | Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic score... Background: Determining surgical management of a spinal metastasis is difficult owing to the involvement of multiple factors. The spinal instability neoplastic... |
| SourceID | nrf pubmedcentral proquest pubmed crossref |
| SourceType | Open Website Open Access Repository Aggregation Database Index Database Enrichment Source |
| StartPage | 337 |
| SubjectTerms | Adult Aged Aged, 80 and over Female Humans Joint Instability - classification Joint Instability - surgery Male Middle Aged Original Severity of Illness Index Spinal Neoplasms - secondary Spinal Neoplasms - surgery 정형외과학 |
| Title | Treatment Strategy for Impending Instability in Spinal Metastases |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/32904056 https://www.proquest.com/docview/2441604363 https://pubmed.ncbi.nlm.nih.gov/PMC7449857 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002621002 |
| Volume | 12 |
| WOSCitedRecordID | wos000562890900011&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | Clinics in Orthopedic Surgery, 2020, 12(3), , pp.337-342 |
| journalDatabaseRights | – providerCode: PRVAON databaseName: DOAJ Directory of Open Access Journals customDbUrl: eissn: 2005-4408 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0065670 issn: 2005-291X databaseCode: DOA dateStart: 20090101 isFulltext: true titleUrlDefault: https://www.doaj.org/ providerName: Directory of Open Access Journals |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3db9MwELfo4IEXBOIrG0wB8YCEIpbYSezHaQJ1SExIDKk8RY7jsmirUzUt2v577uzETcMexgOqlLbXc6P4LvcRn39HyDuqNGMVZKrzPJOQoLA04pmooqNSQT4BHllJ12wiPzvjs5n41q3gt7adQG4Mv74Wy_8qaqCBsHHr7D-I2_8pEOAzCB2OIHY43k3wvnS8Q551JZmnC-x229cHOHRuu-fv-9I2xvqq1xLobVdT2IMX2I2TtmYWF3iaJa7rfGgHe6ml78j8U4MmTZsR9cvGXHjaiX88LRfIfzVint6g8Vl0aODdwwjIPPtqq85mWWDTRNguOOBetjRsbL1jdJOBctGBBaUOA2Zs2SGuRBAMVTctVoGxrfvql-xHXs3XGkKWg4MLP3RC7id5KkSffzu3DXGt7Szor8DBUOHQj37oTvAyMav5bXnJuLx2EK-cPyaPukQjPHYK8oTc0-YpOfbKEfbKEYJyhF45woFyhLUJnXKEW-V4Rn58_nR-Mo26JhqRgtR9HVGpeZrQiiohs0yzkiYQ9OuqZHGsJbyO5vg1RuD-soo151pBlFqySsVCpZo-J3umMfolCXlWVlxBxFhWAuJ4yWU1j-M5T5RgeRnLgLzvZwdm21WSYKOTq-IvGQTkrWddOliVW5lgiotLVRcIgo7vv5riclVAqndaQOICIuMBedNLoADLiMtd0uhm0xYQuMYZdligAXnhJOLPRRMB3ivNApLvyMoz4Al3fzH1hUVfzxkTPM3373IFB-Th9i55RfbWq41-TR6o3-u6XR2SST7jh1YL_wD5hKTp |
| linkProvider | Directory of Open Access Journals |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Treatment+Strategy+for+Impending+Instability+in+Spinal+Metastases&rft.jtitle=Clinics+in+orthopedic+surgery&rft.au=Kim%2C+Yeon+Ho&rft.au=Kim%2C+Junho&rft.au=Chang%2C+Sam+Yeol&rft.au=Kim%2C+Hyoungmin&rft.date=2020-09-01&rft.issn=2005-291X&rft.eissn=2005-4408&rft.volume=12&rft.issue=3&rft.spage=337&rft_id=info:doi/10.4055%2Fcios20014&rft.externalDBID=n%2Fa&rft.externalDocID=10_4055_cios20014 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2005-291X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2005-291X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2005-291X&client=summon |