bims-rebome 2025-10-12 papers

World Neurosurg. 2025 Oct 08. pii: S1878-8750(25)00910-6. [Epub ahead of print] 124552

Clinical Outcomes after Spine Surgery for Patients with Potentially Unstable Metastatic Spinal Disease (Spine Instability Neoplastic Score 7-12): A Systematic Review.

Anthony N Baumann, Grayson M Talaski, Omkar S Anaspure, Blake Stoller, Mathias A Uhler, Erika M Bahler, Ethan J Cottrill, Maria LaMontagne, Keegan T Conry, Gordon Preston, Jacob C Hoffmann.

BACKGROUND: While the surgical management of metastatic spinal disease has wide consensus for "stable" (Spine Instability Neoplastic Score [SINS] 0-6) and "unstable" (SINS 13-18) disease, there is limited consensus regarding spine surgery for patients with "potentially unstable" (SINS 7-12) metastatic disease. We examined the clinical outcomes for these patients after spine surgery.
METHODS: This systematic review examined articles from PubMed, CINAHL, MEDLINE, and Web of Science from database inception until December 18th, 2024. Inclusion criteria were studies that examined clinical outcomes in patients with SINS 7-12 who underwent spine surgery.
RESULTS: Among 111 articles, 10 observational studies were included. Of 1,546 patients, 942 with SINS 7-12 underwent spine surgery for metastases. Average postoperative survival ranged from 10-14 months, with an 80% six-month survival and 59% one-year survival. One article found a statistically significant survival benefit with surgery over radiation, while two did not. Patients with SINS 10-12 were more likely to receive instrumentation than SINS 7-9. Surgery may be more effective than radiation for patient-reported outcomes. Rates of subsequent spine surgery after non-surgical treatments ranged from 4.0%-25.5%. Indications for instrumentation may include osteolytic lesions and >50% vertebral body collapse with no consistency between articles. Cutoff scores of SINS 9 or 10 were associated with the decision to use instrumentation.
CONCLUSION: Patients with potentially unstable metastatic spinal disease (SINS 7-12) treated with surgery have varying survival rates and outcomes in comparison to radiation. Up to 25% of patients with SINS 7-12 may fail non-operative treatments. SINS 7-12 represents heterogeneous grouping of spine instability, with possible subgroups within SINS 7-12.

Keywords: Metastatic Spinal Disease; Spine Instability Neoplastic Score; Surgical Outcomes; Systematic Review

DOI: https://doi.org/10.1016/j.wneu.2025.124552

Bone Jt Open. 2025 Oct 07. 6(10): 1199-1207

Relationships between frailty and surgical outcomes of palliative surgery for spinal metastases : a prospective cohort study.

Takeru Tsujimoto, Tomoya Matsuo, Takashi Yurube, Yoshiki Takeoka, Yutaro Kanda, Ryosuke Kuroda, Kenichiro Kakutani.

Aims: Frailty has recently been associated with postoperative complications and clinical outcomes in various fields. This study aimed to assess the relationships between frailty and surgical outcomes of palliative surgery for spinal metastases and assess the usefulness of the modified five-item frailty index (mFI-5) in this population.
Methods: We prospectively evaluated 273 patients who underwent spinal metastasis surgery from June 2015 to December 2021. The mFI-5 was used to assess frailty, with a score of 0 defined as non-frailty, 1 as pre-frailty, and 2 or more as frailty. The following variables were assessed: background characteristics, complications (Clavien-Dindo grade 2 or higher), postoperative clinical outcomes, and life expectancy. The clinical outcomes compared between the three groups were the performance status (PS), Barthel index, and EuroQoL five-dimension questionnaire (EQ-5D) at six months postoperatively. A multivariate stepwise logistic regression analysis was performed of variables with values of p < 0.1 on the univariate analysis.
Results: The overall complication rate was 19% (52/273). The complication rate was significantly higher in the frailty group (p = 0.005), and patients with a greater mFI-5 score tended to have a higher incidence of postoperative complications. The Kaplan-Meier curve showed that the non-frailty group had a significantly longer survival time than the pre-frailty and frailty groups (p < 0.001). Multivariate logistic regression analysis suggested that mFI-5 is not predictive of postoperative complications and improvement of the EQ-5D, while is predictive of improvement of the PS (odds ratio (OR) 4.22) and Barthel index (OR 4.49).
Conclusion: The current study suggested that mFI-5 is not predictive of postoperative complications and improvement of the EQ-5D, while is predictive of improvement of the PS and Barthel index. Furthermore, palliative surgery for spinal metastases improved the PS, Barthel index, and EQ-5D, even in patients with frailty.

DOI: https://doi.org/10.1302/2633-1462.610.BJO-2024-0253.R1

J Bone Oncol. 2025 Oct;54 100711

Metastatic bone disease in proximal femur. Outcome of surgical treatments. - Do we know what to do?

K Kilk, G Kask, J Nieminen, M K Laitinen.

Background: Skeletal metastases related pathological fracture reconstruction methods in proximal femur range from osteosynthesis to tumor prostheses with acetabular reconstruction, depending on lesion size and location. This retrospective study, of 299 patients surgically treated for proximal femur metastases, investigates implant survival, complications, and functional outcomes of various surgical strategies for treating pathological fractures of the proximal femur.
Patients and methods: This retrospective study of 299 patients surgically treated for proximal femur metastases, investigates implant survival (Kaplan-Meier), complications, and functional outcomes of different surgical strategies. The chi-test and Mann-Witney U test were used for analysis between groups. The subdistribution Hazard Ratio (SHR) of the role of factors affecting implant survival was calculated using competing risk analysis.
Results: Reconstruction methods comprised osteosynthesis (n = 59), hemiarthroplasty (n = 72), total hip replacement (THA) (n = 43), and endoprosthetic replacement (EPR) either with or without acetabular component (n = 125). The precise location and size of the metastases was evaluated. The mean implant survival was 17 months (SD 21.2). Complications occurred in 33 patients, 20 required revision surgery. In prosthesis patients, infections and dislocations were the main complications, while mechanical failure predominated in the osteosynthesis group. Mean implant failure time was 11 months, shortest in THA and osteosynthesis. Functional outcomes in 38 patients showed a mean Oxford Hip Score (OHS) of 33, with no significant differences across methods.
Interpretation: Patient survival is a critical factor in selecting the appropriate reconstruction method for trochanteric metastatic lesions. Osteosynthesis is suitable for patients with a limited life expectancy. In cases of metastases involving the head-neck anatomical region, arthroplasty with acetabular reconstruction offers no advantage over hemiarthroplasty. With our data there was no statistical difference in functional outcome between different surgical methods.

Keywords: Bone metastases; Impending fracture; Metastatic fracture; Pathological fracture; Proximal femur

DOI: https://doi.org/10.1016/j.jbo.2025.100711

Neurosurgery. 2025 Oct 07.

Repeat Stereotactic Body Radiation Therapy for Spinal Metastases: Long-Term Outcomes and Toxicity.

Suchet Taori, Samuel Adida, Serah Choi, Travis J McCaw, Steven A Burton, John C Flickinger, Roberta K Sefcik, Peter C Gerszten.

BACKGROUND AND OBJECTIVES: Although stereotactic body radiation therapy (SBRT) provides durable local tumor control, management after cases of local failure (LF) continues to remain unclear. This study is one of the largest to report outcomes after a repeat course of spine SBRT after initial SBRT LF.
METHODS: A prospectively maintained single-institution database of patients treated with SBRT was analyzed. Inclusion criteria consisted of patients with spinal metastases who underwent a repeat course of SBRT for same vertebral-level LF after initial SBRT. The median dose for repeat SBRT was 16 Gy (range: 12-30) in 1-3 fractions.
RESULTS: A total of 55 patients with 67 metastases met inclusion criteria. Of these, 45 metastases (67%) were irradiated with conventional external beam radiation therapy (cEBRT) before the initial SBRT. The median interval between initial and repeat SBRT was 8 months (range: 2-125). Rates of 6-month, 1-year, and 2-year local control were 96%, 85%, and 77%, respectively. On univariable analysis, only previous cEBRT (P = .014, hazard ratio [HR]: 0.13, 95% CI: 0.02-0.66) was associated with superior local control. Rates of 6-month, 1-year, and 2-year overall survival (OS) were 69%, 53%, and 35%, respectively. Univariable analysis identified age ≤65 years (P = .036, HR: 1.74, 95% CI: 1.04-2.93) and Karnofsky Performance Score >70 (P = .038, HR: 0.57, 95% CI: 0.33-0.97) as associated with superior OS. No tested prognostic factors remained associated with OS on multivariable analysis. Clinical improvement or stability of pain was observed after 95%, 82%, and 75% of treatments at 3, 6, and 12 months, respectively. Accounting for the competing risk of death, the 6-month, 1-year, and 2-year vertebral compression fracture cumulative incidence rates were 6%, 20%, and 25%, respectively. No radiation neuropathy or myelopathy was observed in the follow-up period.
CONCLUSION: Repeat SBRT is a safe and effective salvage therapy for patients with recurrent spinal metastases after initial same vertebral-level SBRT LF, even in heavily pretreated patients previously irradiated with cEBRT.

Keywords: Reirradiation; Spinal metastases; Spine stereotactic body radiation therapy; Stereotactic body radiation therapy; Stereotactic radiosurgery; Tumor control

DOI: https://doi.org/10.1227/neu.0000000000003772