Surgical Treatment of Spinal Metastases-A Retrospective Single-Center Study of 268 Patients

Background/Objectives: Cancer is the second leading cause of death, and spinal metastases may occur in up to 40% of patients with cancer. The purpose of the current study is to evaluate survival after surgical treatment of spinal metastases, and to identify risk factors that might shorten postoperative survival. Methods: Two-hundred sixty-eight patients who underwent surgery due to spinal metastases at a single center between 1990 and 2019 were evaluated retrospectively. Various variables and prognostic scores were analyzed to assess their impact on postoperative survival. Results: Two-hundred thirty-three patients (86.9%) died with a mean time from surgery to death of 14.84 months. Twelve months postoperatively, the survival rate of the entire cohort was 41.8%. Patients who were 65 years or older and were bedbound or in a wheelchair had a significantly shorter survival rate (p = 0.007). Further risk factors for a worse survival rate were: higher preoperative ASA-score (β = 2.19, 95% CI 1.34-3.57; p = 0.002), higher age at the time of surgery (β = 1.03, 95% CI 1.00-1.05; p = 0.041), presence of preoperative additional extraspinal bone metastases (β = 1.15, 95% CI 1.01-3.76; p = 0.047), ambulatory status (β = 1.21, 95% CI 1.04-1.4; p = 0.013), and elevated CRP-value > 5 mg/dL (β = 3.02, 95% CI 1.59-5.73; p = 0.001). Conclusions: Patients who are 65 years or older and bedbound or in a wheelchair had a significantly shorter survival period. When considering treatment options for patients with spinal metastases, a higher ASA-score, a higher age at the time of surgery, the presence of preoperative additional extraspinal bone metastases, being bedbound or in a wheelchair, and an elevated CRP-value > 5 mg/dL should be considered as significant risk factors for a worse survival rate. Available prognostic scores may only predict a patient's survival accurately in the short-term follow-up.