Survivorship and Functional Outcomes after Surgery for Metastatic Spinal Disease Including Cord Compression:...

Metastatic spinal disease, including cord compression, represents a significant complication of advanced malignancy and is associated with pain, neurological deficit, and reduced quality of life. Surgical intervention continues to play a vital role in management for selected patients. Survivorship following surgery varies widely and is influenced by tumor biology and systemic disease burden.

The aim of the study is to evaluate survival and functional outcomes in patients surgically treated for metastatic spinal disease including cord compression, by a single surgeon at a UK tertiary spinal center.

Retrospective case series of prospectively collected data from 45 patients undergoing surgery for metastatic spinal disease, including cord compression. Data included demographics, tumor histology, Bilsky grade, spinal instability neoplastic score (SINS), neurological status, surgical procedure, complications, survival, and functional outcomes (Visual Analog Scale [VAS], EuroQol-5 dimension (EQ-5D), and Oswestry disability index [ODI]). Paired pre- and post-operative comparisons were performed using appropriate statistical tests (paired t-test or Wilcoxon), and survival analysis was conducted using Kaplan-Meier and Cox regression.

Mean patient age was 61.7 ± 12.9 years (Range 23.9-81.3 years), with 51% female predominance. The most common primary tumors were lung (20%), breast (17.8%), myeloma (15.6%), and renal cell carcinoma (13.3%). High-grade epidural spinal cord compression (Bilsky 2-3) was present in 60%. At presentation, 65% had no neurological deficit, 19% had radicular symptoms, and 14% had incomplete spinal cord injury. Most patients had intermediate SINS scores (66%), while 34% were classified as unstable. Decompression with stabilization was most frequent (67%), followed by debulking (20%) and complex/reconstructive procedures (13%). Post-operative complications occurred in 11% (5/45), with no peri-operative deaths. In the subset with complete functional data (n = 28), mean VAS improved from 47.3 to 68.9 and EQ-5D index from 0.17 to 0.56 (P < 0.001). Median post-operative survival was 12 months, mean survival 31.4 months, and 30-day mortality was 4.3%. Tumor histology was a significant predictor of survival (log-rank χ2 = 14.4, P = 0.006), with myeloma and breast cancer patients showing the most favorable outcomes. Post-operative ODI category was also associated with survival (log-rank χ² = 12.2, P = 0.028).

Surgery for metastatic spinal disease including cord compression was associated with meaningful functional improvement and survival outcomes that are consistent with historical expectations. These findings support the continued role of surgical intervention as part of a multidisciplinary approach in appropriately selected patients with symptomatic disease.