Introduction: Surgery for spinal metastasis can be associated with great morbidity and survival times are often less than a year. Recurrence of metastatic lesions is quite common and it remains unclear whether repeat surgery is effective. In this study, we assessed for independent predictors and risk factors for complications, recurrence, and survival.
Methods: Between 2005 to 2011, a consecutive population of adult patients who underwent surgery for spinal metastasis was identified. Utilizing multivariate logistic regression and Cox-proportional hazard regression, we assessed for independent predictors and risk factors for complications, recurrence, and survival (at 6months, 1-year, and 2-years). Furthermore, the impact of repeat surgery on survival was specifically assessed with multivariable analysis.
Results: A total of 113 patients were included in the final analysis. Complication rate was 18.6%. Independent predictors of higher complications were age greater than 40 years and 3 or more contiguous levels of involvement. Overall recurrence was 34.5%, and melanoma was significantly associated with higher risk of recurrence. Other than cancer type, however, recurrence depended mainly on survival (longer survival times were associated with higher rates of recurrence). Overall mean survival was 12.5 months. Patients that underwent repeat surgery had longer mean survival times than patients without repeat surgery for recurrence (31.2 months vs. 12.8 months), and repeat surgery was independently associated with higher survival rates. In addition to previously identified predictors of survival (preoperative ambulation, Karnofsky Performance Score, radiotherapy, cancer type, presence of extraspinal metastasis, and metastasis involving less than 3 contiguous vertebrae), pain on presentation was also associated with survival as well.
Conclusions: Our findings suggests that repeat surgery may be a viable option in patients with metastatic recurrence, and may offer prolonged survival presumably by improved functionality and mitigating associated complications from neurologic injury. Age and 3 or more contiguous levels of involvement were predictors of increased complication.
Patient Care: The findings of this study will provide information on the complication rate and predictors of increased complication with spinal surgery for metastasis. In addition, the impact of redo surgery for recurrent spinal metastasis is presented which will help treating surgeons determine whether further surgery for recurrent spine disease is warranted.
Learning Objectives: 1. Describe predictors for increased survival for metastatic spine disease.
2. Describes risk factors for tumor recurrence.
3. Understand complications associated with surgical treatment of spinal metastatic lesions.