Complications After Percutaneous Pedicle Screw Fixation for the Treatment of Unstable Spinal Metastases

Complications after surgical stabilization for the treatment of unstable spinal metastases are common. Less invasive surgical (LIS) procedures are potentially associated with a lower risk of complications; however, little is known regarding the complications after LIS procedures for the treatment of spinal metastases. Our primary objective was to determine the characteristics and rate of complications after percutaneous pedicle screw fixation (PPSF) for the treatment of mechanically unstable spinal metastases. The secondary objective was to identify factors associated with the occurrence of complications and survival.

A retrospective multicenter cohort study of patients who underwent PPSF between 2009 and 2014 for the treatment of unstable spinal metastases was performed. Patient data pertaining to demographics, diagnosis, treatment, neurologic function, complications, and survival were collected.

A total of 101 patients were identified, 45 men (45 %) and 56 women (55 %) with a mean age of 60.3 ± 11.2 years. The median operating time was 122 (range 57-325) minutes with a median blood loss of 100 ml (based on 41 subjects). Eighty-eight patients (87 %) ambulated within the first 3 days after surgery. An overall median survival of 11.0 (range 0-70) months was observed, with 79 % of the patients alive at 3 months after treatment. Eighteen patients experienced a total of 30 complications; nonsurgical complications were the most commonly encountered. Prolonged operating time was independently associated with an increased risk of complications.

A complication rate of 18 % was found after PPSF for unstable spinal metastases. Potential advantages of less invasive treatment are limited blood loss and high early ambulation rate.