A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis
Purpose As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the gu...
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| Veröffentlicht in: | European spine journal 2024-05, Vol.33 (5), p.1868-1898 |
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| creator | Yu, Wenlong Chen, Dingbang Ding, Xing Qiao, Liang Zhang, Luosheng Gao, Xin Yan, Yinjie Mo, Wen Ma, Junming Yin, Mengchen |
| description | Purpose
As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster.
Methods
We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline’s quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale.
Results
Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as “recommended,” and three guidelines were evaluated as “recommended with modifications.” Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn’t recommend iliac bone graft and three guidelines recommended PMMA bone cement.
Conclusion
Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendatio |
| doi_str_mv | 10.1007/s00586-023-08127-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2932020169</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3068970310</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-3d0e622e43e30eca13082fef8f166a4e0492b8259b6f7cff80620bfbaf4d8b743</originalsourceid><addsrcrecordid>eNp9kU1rGzEQhkVJqZ20f6CHsJBLL9uOPqzVHo1J2kCgl_YstPLIyOxXNLuH-NdHtZ0UcggIJN555h0xL2NfOXznANUPAlgZXYKQJRguqvLwgS25kqKEWooLtoRaQakrXi_YJdEegK9q0J_YQhoFleZqydy68ClO0bu2cOOYXKT8GkLh29gf1az5XMdiN8ctZhWpGPqC5rQ71qeEbuqwn6gIQypojH1WO5wc5RPpM_sYXEv45Xxfsb93t382v8qH3z_vN-uH0kuhp1JuAbUQqCRKQO-4BCMCBhO41k4hqFo0RqzqRofKh2BAC2hC44LamqZS8op9O_mOaXickSbbRfLYtq7HYSYr8k5AANd1Rm_eoPthTvnbZCVoU1cgOWRKnCifBqKEwY4pdi49WQ72XwD2FIDNAdhjAPaQm67P1nPT4fa15WXjGZAngHKp32H6P_sd22fYB5I8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3068970310</pqid></control><display><type>article</type><title>A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Yu, Wenlong ; Chen, Dingbang ; Ding, Xing ; Qiao, Liang ; Zhang, Luosheng ; Gao, Xin ; Yan, Yinjie ; Mo, Wen ; Ma, Junming ; Yin, Mengchen</creator><creatorcontrib>Yu, Wenlong ; Chen, Dingbang ; Ding, Xing ; Qiao, Liang ; Zhang, Luosheng ; Gao, Xin ; Yan, Yinjie ; Mo, Wen ; Ma, Junming ; Yin, Mengchen</creatorcontrib><description>Purpose
As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster.
Methods
We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline’s quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale.
Results
Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as “recommended,” and three guidelines were evaluated as “recommended with modifications.” Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn’t recommend iliac bone graft and three guidelines recommended PMMA bone cement.
Conclusion
Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.</description><identifier>ISSN: 0940-6719</identifier><identifier>ISSN: 1432-0932</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-023-08127-z</identifier><identifier>PMID: 38407614</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Bone grafts ; Bone implants ; Bone surgery ; Cement ; Content analysis ; Humans ; Medical personnel ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Neurosurgery ; Palliation ; Patients ; Polymethylmethacrylate ; Practice Guidelines as Topic - standards ; Radiation therapy ; Reconstructive surgery ; Review Article ; Spinal cord ; Spinal Neoplasms - secondary ; Spinal Neoplasms - surgery ; Standardization ; Surgery ; Surgical Orthopedics</subject><ispartof>European spine journal, 2024-05, Vol.33 (5), p.1868-1898</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. 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.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-3d0e622e43e30eca13082fef8f166a4e0492b8259b6f7cff80620bfbaf4d8b743</cites><orcidid>0000-0001-7404-1495</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-023-08127-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-023-08127-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38407614$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yu, Wenlong</creatorcontrib><creatorcontrib>Chen, Dingbang</creatorcontrib><creatorcontrib>Ding, Xing</creatorcontrib><creatorcontrib>Qiao, Liang</creatorcontrib><creatorcontrib>Zhang, Luosheng</creatorcontrib><creatorcontrib>Gao, Xin</creatorcontrib><creatorcontrib>Yan, Yinjie</creatorcontrib><creatorcontrib>Mo, Wen</creatorcontrib><creatorcontrib>Ma, Junming</creatorcontrib><creatorcontrib>Yin, Mengchen</creatorcontrib><title>A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster.
Methods
We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline’s quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale.
Results
Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as “recommended,” and three guidelines were evaluated as “recommended with modifications.” Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn’t recommend iliac bone graft and three guidelines recommended PMMA bone cement.
Conclusion
Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.</description><subject>Bone grafts</subject><subject>Bone implants</subject><subject>Bone surgery</subject><subject>Cement</subject><subject>Content analysis</subject><subject>Humans</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Neurosurgery</subject><subject>Palliation</subject><subject>Patients</subject><subject>Polymethylmethacrylate</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Radiation therapy</subject><subject>Reconstructive surgery</subject><subject>Review Article</subject><subject>Spinal cord</subject><subject>Spinal Neoplasms - secondary</subject><subject>Spinal Neoplasms - surgery</subject><subject>Standardization</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><issn>0940-6719</issn><issn>1432-0932</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1rGzEQhkVJqZ20f6CHsJBLL9uOPqzVHo1J2kCgl_YstPLIyOxXNLuH-NdHtZ0UcggIJN555h0xL2NfOXznANUPAlgZXYKQJRguqvLwgS25kqKEWooLtoRaQakrXi_YJdEegK9q0J_YQhoFleZqydy68ClO0bu2cOOYXKT8GkLh29gf1az5XMdiN8ctZhWpGPqC5rQ71qeEbuqwn6gIQypojH1WO5wc5RPpM_sYXEv45Xxfsb93t382v8qH3z_vN-uH0kuhp1JuAbUQqCRKQO-4BCMCBhO41k4hqFo0RqzqRofKh2BAC2hC44LamqZS8op9O_mOaXickSbbRfLYtq7HYSYr8k5AANd1Rm_eoPthTvnbZCVoU1cgOWRKnCifBqKEwY4pdi49WQ72XwD2FIDNAdhjAPaQm67P1nPT4fa15WXjGZAngHKp32H6P_sd22fYB5I8</recordid><startdate>20240501</startdate><enddate>20240501</enddate><creator>Yu, Wenlong</creator><creator>Chen, Dingbang</creator><creator>Ding, Xing</creator><creator>Qiao, Liang</creator><creator>Zhang, Luosheng</creator><creator>Gao, Xin</creator><creator>Yan, Yinjie</creator><creator>Mo, Wen</creator><creator>Ma, Junming</creator><creator>Yin, Mengchen</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7404-1495</orcidid></search><sort><creationdate>20240501</creationdate><title>A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis</title><author>Yu, Wenlong ; Chen, Dingbang ; Ding, Xing ; Qiao, Liang ; Zhang, Luosheng ; Gao, Xin ; Yan, Yinjie ; Mo, Wen ; Ma, Junming ; Yin, Mengchen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-3d0e622e43e30eca13082fef8f166a4e0492b8259b6f7cff80620bfbaf4d8b743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Bone grafts</topic><topic>Bone implants</topic><topic>Bone surgery</topic><topic>Cement</topic><topic>Content analysis</topic><topic>Humans</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Neurosurgery</topic><topic>Palliation</topic><topic>Patients</topic><topic>Polymethylmethacrylate</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Radiation therapy</topic><topic>Reconstructive surgery</topic><topic>Review Article</topic><topic>Spinal cord</topic><topic>Spinal Neoplasms - secondary</topic><topic>Spinal Neoplasms - surgery</topic><topic>Standardization</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yu, Wenlong</creatorcontrib><creatorcontrib>Chen, Dingbang</creatorcontrib><creatorcontrib>Ding, Xing</creatorcontrib><creatorcontrib>Qiao, Liang</creatorcontrib><creatorcontrib>Zhang, Luosheng</creatorcontrib><creatorcontrib>Gao, Xin</creatorcontrib><creatorcontrib>Yan, Yinjie</creatorcontrib><creatorcontrib>Mo, Wen</creatorcontrib><creatorcontrib>Ma, Junming</creatorcontrib><creatorcontrib>Yin, Mengchen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yu, Wenlong</au><au>Chen, Dingbang</au><au>Ding, Xing</au><au>Qiao, Liang</au><au>Zhang, Luosheng</au><au>Gao, Xin</au><au>Yan, Yinjie</au><au>Mo, Wen</au><au>Ma, Junming</au><au>Yin, Mengchen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2024-05-01</date><risdate>2024</risdate><volume>33</volume><issue>5</issue><spage>1868</spage><epage>1898</epage><pages>1868-1898</pages><issn>0940-6719</issn><issn>1432-0932</issn><eissn>1432-0932</eissn><abstract>Purpose
As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster.
Methods
We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline’s quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale.
Results
Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as “recommended,” and three guidelines were evaluated as “recommended with modifications.” Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn’t recommend iliac bone graft and three guidelines recommended PMMA bone cement.
Conclusion
Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38407614</pmid><doi>10.1007/s00586-023-08127-z</doi><tpages>31</tpages><orcidid>https://orcid.org/0000-0001-7404-1495</orcidid></addata></record> |
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| subjects | Bone grafts Bone implants Bone surgery Cement Content analysis Humans Medical personnel Medicine Medicine & Public Health Metastases Metastasis Neurosurgery Palliation Patients Polymethylmethacrylate Practice Guidelines as Topic - standards Radiation therapy Reconstructive surgery Review Article Spinal cord Spinal Neoplasms - secondary Spinal Neoplasms - surgery Standardization Surgery Surgical Orthopedics |
| title | A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis |
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