Comparison of open and percutaneous instrumented fixation for the treatment of spinal metastases

The primary goals in surgical treatment of spinal metastases are neural decompression and spinal stabilization. Understanding a patient's functional and oncological status plays a key role in patient selection. Careful patient selection and determining the ideal surgical strategy are paramount to achieving successful outcomes in spinal oncology given the high risk for perioperative morbidity. The aim of this study was to examine instrumented fixation for treatment of spinal metastatic disease and compare outcomes of open versus percutaneous fixation to understand factors that might influence short- and long-term survival.

A retrospective study of patients with metastatic spine tumors who underwent instrumented fixation with or without decompression from 2018 to 2023 at a single institution was performed. Demographic and oncological information, and preoperative and postoperative performance and pain scores, as well as history of surgical or radiation treatment, were collected. The cohort was divided into those who underwent open fixation versus those who underwent percutaneous fixation, and surgical data and instability scores were collected.

A total of 273 patients (127 female and 146 male, mean age 63.6 ± 11.9 years) who underwent instrumented fixation for the treatment of spinal metastases were identified. Univariate analysis showed that the Karnofsky Performance Status (KPS) score at the time of surgery, postoperative hospital length of stay (LOS), and total LOS correlated with both 3- and 12-month survival. Multivariate analysis showed that sex, KPS score, previous radiation therapy, and postoperative LOS were associated with 3- and 12-month survival. There was no significant difference between groups in the mean KPS score at the time of surgery (73.6 vs 73.1, p = 0.354), but the percutaneous fixation group had a higher mean KPS score at 1 year (80.5 vs 84, p = 0.038). Preoperative pain scores were higher in the percutaneous group (mean 6.7 vs 7.6, p = 0.035) than the open fixation group, but there was no difference between groups at 1 year (mean 2.4 vs 2.6, p = 0.861).

Preoperative performance status, prior radiation therapy, and postoperative hospital LOS were associated with overall survival following instrumented fixation for spinal metastases. Overall outcomes were equivocal in open versus percutaneous fixation procedures, with a higher KPS score at 1 year in the percutaneous cohort.