Local Recurrence and Development of Spinal Cord Syndrome during Follow-Up after Surgical Treatment of Metastatic Spine Disease

SIMPLE SUMMARY: Metastatic spinal disease is a devastating disease often associated with a reduced quality of life for patients. In these patients, quality of life can be reduced due to peripheral or axial pain, mechanical instability, fractures or neurological impairments. Treatment is interdisciplinary and, in many cases, includes surgery followed by radiotherapy. In some cases, patients develop novel neurologic deficits in the time after or during treatment. This study searches for risk factors leading to novel neurologic deficits. This study found a long time of more than 35 d between surgery and radiotherapy to be an important risk factor for occurrence of novel neurologic deficits. ABSTRACT: Background: Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. Methods: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. Results: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up. Conclusion: Surgical treatment of spinal metastatic disease improves patients’ quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.