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Abstract：
OBJECTIVE: Despite advancements in spinal metastasis surgery techniques and the rapid development of multidisciplinary treatment models, we aimed to explore the clinical efficacy of spinal metastasis surgery performed by a combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system, compared with the Revised Tokuhashi scoring system.
METHODS: Clinical data from 102 patients with spinal metastases who underwent surgery at three affiliated hospitals of Zunyi Medical University from December 2017 to June 2022 were analysed. The patients were randomly assigned to two groups: 52 patients in the treatment group involving the combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system (i.e., the combined group), and 50 patients in the treatment group involving the Revised Tokuhashi scoring system only (i.e., the revised TSS-only group). Moreover, there were no statistically significant differences in preoperative general data or indicators between the two groups. Intraoperative and postoperative complications, average hospital stay, mortality rate, and follow-up observation indicators, including the visual analogue scale (VAS) score for pain, Eastern Cooperative Oncology Group (ECOG) performance status, Karnofsky Performance Status (KPS) score, negative psychological assessment score (using the Self-Rating Anxiety Scale, [SAS]), and neurological function recovery score (Frankel functional classification) were compared between the two groups.
RESULTS: All 102 patients successfully completed surgery and were discharged. The follow-up period ranged from 12 to 24 months, with an average of (13.2 ± 2.4) months. The patients in the combined group experienced fewer complications such as surgical wound infections 3 patients(5.77%), intraoperative massive haemorrhage 2 patients(3.85%), cerebrospinal fluid leakage 2 patients(3.85%), deep vein thrombosis 4 patients(7.69%),and neurological damage 1 patient(1.92%), than patients in the revised TSS-only group (wound infections,11 patients(22%); intraoperative massive haemorrhage, 8 patients(16%);cerebrospinal fluid leakage,5 patients(10%);deep vein thrombosis,13 patients (26%); neurological damage,2 patients (4%). Significant differences were found between the two groups in terms of surgical wound infections, intraoperative massive haemorrhage, and deep vein thrombosis (P < 0.05). The average postoperative hospital stay in the combined group (7.94 ± 0.28 days) was significantly shorter than that in the revised TSS-only group (10.33 ± 0.30 days) (P < 0.05). Long-term follow-up (1 month, 3 months, 6 months, and 1 year postoperatively) revealed better clinical outcomes in the combined group than in the revised TSS-only group in terms of VAS scores, overall KPS%, neurological function status Frankel classification, ECOG performance status, and SAS scores.(P < 0.05).
CONCLUSIONS: A multidisciplinary team using the NOMS combined with the Revised Tokuhashi scoring system for spinal metastasis surgery showed better clinical efficacy than the sole use of the Revised Tokuhashi scoring system. This personalized, precise, and rational treatment significantly improves patient quality of life, shortens hospital stay, reduces intraoperative and postoperative complications, and lowers mortality rates.
METHODS: Clinical data from 102 patients with spinal metastases who underwent surgery at three affiliated hospitals of Zunyi Medical University from December 2017 to June 2022 were analysed. The patients were randomly assigned to two groups: 52 patients in the treatment group involving the combined NOMS decision system-utilizing multidisciplinary team and Revised Tokuhashi scoring system (i.e., the combined group), and 50 patients in the treatment group involving the Revised Tokuhashi scoring system only (i.e., the revised TSS-only group). Moreover, there were no statistically significant differences in preoperative general data or indicators between the two groups. Intraoperative and postoperative complications, average hospital stay, mortality rate, and follow-up observation indicators, including the visual analogue scale (VAS) score for pain, Eastern Cooperative Oncology Group (ECOG) performance status, Karnofsky Performance Status (KPS) score, negative psychological assessment score (using the Self-Rating Anxiety Scale, [SAS]), and neurological function recovery score (Frankel functional classification) were compared between the two groups.
RESULTS: All 102 patients successfully completed surgery and were discharged. The follow-up period ranged from 12 to 24 months, with an average of (13.2 ± 2.4) months. The patients in the combined group experienced fewer complications such as surgical wound infections 3 patients(5.77%), intraoperative massive haemorrhage 2 patients(3.85%), cerebrospinal fluid leakage 2 patients(3.85%), deep vein thrombosis 4 patients(7.69%),and neurological damage 1 patient(1.92%), than patients in the revised TSS-only group (wound infections,11 patients(22%); intraoperative massive haemorrhage, 8 patients(16%);cerebrospinal fluid leakage,5 patients(10%);deep vein thrombosis,13 patients (26%); neurological damage,2 patients (4%). Significant differences were found between the two groups in terms of surgical wound infections, intraoperative massive haemorrhage, and deep vein thrombosis (P < 0.05). The average postoperative hospital stay in the combined group (7.94 ± 0.28 days) was significantly shorter than that in the revised TSS-only group (10.33 ± 0.30 days) (P < 0.05). Long-term follow-up (1 month, 3 months, 6 months, and 1 year postoperatively) revealed better clinical outcomes in the combined group than in the revised TSS-only group in terms of VAS scores, overall KPS%, neurological function status Frankel classification, ECOG performance status, and SAS scores.(P < 0.05).
CONCLUSIONS: A multidisciplinary team using the NOMS combined with the Revised Tokuhashi scoring system for spinal metastasis surgery showed better clinical efficacy than the sole use of the Revised Tokuhashi scoring system. This personalized, precise, and rational treatment significantly improves patient quality of life, shortens hospital stay, reduces intraoperative and postoperative complications, and lowers mortality rates.
摘要：
目的：尽管脊柱转移手术技术的进步和多学科治疗模式的快速发展，我们旨在探讨联合NOMS决策系统-利用多学科团队和修订的Tokuhashi评分系统进行脊柱转移手术的临床疗效，与修订后的德桥评分系统相比。
方法：对2017年12月至2022年6月在遵义医学院附属三家医院接受手术治疗的102例脊柱转移瘤患者的临床资料进行分析。将患者随机分为两组：治疗组中的52例患者，涉及结合NOMS决策系统-利用多学科团队和修订的Tokuhashi评分系统（即，合并组)，治疗组中50名患者仅涉及修订的德桥评分系统(即，修订后的仅TSS组)。此外，两组患者术前一般资料和指标差异无统计学意义.术中和术后并发症，平均住院时间,死亡率,和后续观察指标，包括疼痛的视觉模拟量表（VAS）评分，东部肿瘤协作组（ECOG）的表现状况，Karnofsky绩效状态（KPS）得分，负面心理评估评分(使用焦虑自评量表，[SAS])，比较两组神经功能恢复评分(Frankel功能分级)。
结果：102例患者均顺利完成手术并出院。随访时间为12~24个月,平均(13.2±2.4)个月。联合组患者手术切口感染等并发症较少3例(5.77%),术中大出血2例(3.85%),脑脊液漏2例(3.85%),深静脉血栓形成4例(7.69%),神经损伤1例（1.92%），比修订的仅TSS组的患者(伤口感染，11例（22%）；术中大出血，8例（16%）；脑脊液漏，5例（10％）；深静脉血栓形成，13例（26%）；神经损伤，2例(4%)。两组在手术伤口感染方面存在显著差异,术中大出血,深静脉血栓形成(P<0.05)。联合组术后平均住院时间(7.94±0.28天)明显短于单纯TSS改良组(10.33±0.30天)(P<0.05)。长期随访（1个月，3个月,6个月,术后1年）在VAS评分方面，联合组的临床结局优于仅修订的TSS组，总体KPS%，神经功能状态Frankel分类，ECOG性能状态,SAS评分。(P<0.05)。
结论：使用NOMS结合修订的Tokuhashi评分系统的多学科团队在脊柱转移手术中显示出比单独使用修订的Tokuhashi评分系统更好的临床疗效。这个个性化的，精确，合理的治疗显著提高了患者的生活质量,缩短住院时间,减少术中和术后并发症，并降低死亡率。
方法：对2017年12月至2022年6月在遵义医学院附属三家医院接受手术治疗的102例脊柱转移瘤患者的临床资料进行分析。将患者随机分为两组：治疗组中的52例患者，涉及结合NOMS决策系统-利用多学科团队和修订的Tokuhashi评分系统（即，合并组)，治疗组中50名患者仅涉及修订的德桥评分系统(即，修订后的仅TSS组)。此外，两组患者术前一般资料和指标差异无统计学意义.术中和术后并发症，平均住院时间,死亡率,和后续观察指标，包括疼痛的视觉模拟量表（VAS）评分，东部肿瘤协作组（ECOG）的表现状况，Karnofsky绩效状态（KPS）得分，负面心理评估评分(使用焦虑自评量表，[SAS])，比较两组神经功能恢复评分(Frankel功能分级)。
结果：102例患者均顺利完成手术并出院。随访时间为12~24个月,平均(13.2±2.4)个月。联合组患者手术切口感染等并发症较少3例(5.77%),术中大出血2例(3.85%),脑脊液漏2例(3.85%),深静脉血栓形成4例(7.69%),神经损伤1例（1.92%），比修订的仅TSS组的患者(伤口感染，11例（22%）；术中大出血，8例（16%）；脑脊液漏，5例（10％）；深静脉血栓形成，13例（26%）；神经损伤，2例(4%)。两组在手术伤口感染方面存在显著差异,术中大出血,深静脉血栓形成(P<0.05)。联合组术后平均住院时间(7.94±0.28天)明显短于单纯TSS改良组(10.33±0.30天)(P<0.05)。长期随访（1个月，3个月,6个月,术后1年）在VAS评分方面，联合组的临床结局优于仅修订的TSS组，总体KPS%，神经功能状态Frankel分类，ECOG性能状态,SAS评分。(P<0.05)。
结论：使用NOMS结合修订的Tokuhashi评分系统的多学科团队在脊柱转移手术中显示出比单独使用修订的Tokuhashi评分系统更好的临床疗效。这个个性化的，精确，合理的治疗显著提高了患者的生活质量,缩短住院时间,减少术中和术后并发症，并降低死亡率。
