RT Journal Article
SR Electronic
T1 Preoperative Predictors of Survival in Patients With Spinal Metastatic Disease
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8444
DO 10.14444/8444
A1 Stephen P. Miranda
A1 Patricia Zadnik Sullivan
A1 Ahmed Albayar
A1 Ashwin G. Ramayya
A1 Rachel Blue
A1 Zarina S. Ali
A1 Neil Malhotra
A1 Paul Marcotte
A1 Jang Yoon
A1 Comron Saifi
A1 William C. Welch
A1 James Schuster
A1 Ali K. Ozturk
YR 2023
UL http://ijssurgery.com//content/early/2023/03/08/8444.abstract
AB Background There remains a number of factors thought to be associated with survival in spinal metastatic disease, but evidence of these associations is lacking. In this study, we examined factors associated with survival among patients undergoing surgery for spinal metastatic disease.Methods We retrospectively examined 104 patients who underwent surgery for spinal metastatic disease at an academic medical center. Of those patients, 33 received local preoperative radiation (PR) and 71 had no PR (NPR). Disease-related variables and surrogate markers of preoperative health were identified, including age, pathology, timing of radiation and chemotherapy, mechanical instability by spine instability neoplastic score, American Society of Anesthesiologists (ASA) classification, Karnofsky performance status (KPS), and body mass index (BMI). We performed survival analyses using a combination of univariate and multivariate Cox proportional hazards models to assess significant predictors of time to death.Results Local PR (Hazard Ratio [HR] = 1.84, P = 0.034), mechanical instability (HR = 1.11, P = 0.024), and melanoma (HR = 3.60, P = 0.010) were significant predictors of survival on multivariate analysis when controlling for confounders. PR vs NPR cohorts exhibited no statistically significant differences in preoperative age (P = 0.22), KPS (P = 0.29), BMI (P = 0.28), or ASA classification (P = 0.12). NPR patients had more reoperations for postoperative wound complications (11.3% vs 0%, P < 0.001).Conclusions In this small sample, PR and mechanical instability were significant predictors of postoperative survival, independent of age, BMI, ASA classification, and KPS and in spite of fewer wound complications in the PR group. It is possible that PR was a surrogate of more advanced disease or poor response to systemic therapy, independently portending a worse prognosis. Future studies in larger, more diverse populations are crucial for understanding the relationship between PR and postoperative outcomes to determine the optimal timing for surgical intervention.Clinical Relevance These findings are clinically relevent as they provide insight into factors associated with survival in metastatic spinal disease.Level of Evidence 3.