Contreras ZMF, González MA, Guzmán CJE, Sotelo MIJ, Fuentes MA, Verde BJC, Santos BH, Santos UI

Language: Spanish
References: 12
Page: 12-22
PDF size: 378.36 Kb.

ABSTRACT

Introduction: vertebral destruction syndrome is defined as the set of pathologies that affect the structural integrity and modify the normal architecture of the vertebra, producing spinal instability and neurological deficit. 30% of patients with a disseminated tumor have spinal metastases, and in the cases of certain specific tumors (lung, prostate, breast) it can reach 70%. Of all of them, up to 10% will develop spinal cord compression syndrome secondary to the tumor. The diagnosis of these entities is important for the treatment and prognosis of the patient; The NOMS framework proposes a protocolized scheme aimed at improving the patient's prognosis, as well as incorporating sentinel decision points in the treatment of spinal metastases. Objectives: to evaluate the effectiveness and implementation of the NOMS Safety Framework in the treatment of spinal metastases, providing practical guidance to improve clinical outcomes and patient safety. Material and methods: prospective cross-sectional, descriptive study of consecutive cases of a universe of 26 patients with a diagnosis of vertebral destruction syndrome in the period from November 1, 2021, to July 15, 2023, in a third level medical center. The NOMS evaluation algorithm was used in all cases for the therapeutic decision, to determine the diagnostic value of the different tests in the framework. A p < 0.05 was considered statistically significant when using the NOMS framework, as they are accessible and reproducible in all settings. Results: in all cases in addition to surgical treatment, patients received adjuvant treatment with radiotherapy and/or chemotherapy according to the indications of the specialist physician and current NOMS guidelines. Discussion: the NOMS framework emerges as a guiding tool for decision-making in the therapeutic management of patients with spinal metastases, combining both oncological (radiotherapy or radiosurgery, chemotherapy and immunotherapy) and surgical treatment strategies. Conclusions: the NOMS paradigm provides a decision framework that incorporates sentinel decision points in the treatment of spinal metastases. Based on these four criteria, management algorithms have been used to facilitate decision making. Consideration of tumor sensitivity to radiation along with the degree of epidural extension allows determination of optimal radiation treatment and the need for surgical decompression. Mechanical stability of the spine and systemic disease considerations further help determine the need and feasibility of surgical intervention. This research work seeks to provide a comprehensive evaluation of the NOMS Safety Framework for the treatment of spinal metastases, in order to help healthcare professionals implement evidence-based best practices.

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