One-Year Survival Following Surgical Management of Spinal Metastases

Abstract Background Metastatic spinal disease is a common complication of advanced cancer that causes pain, neurological deficits, and mechanical instability. Objective To identify factors associated with survival and motor function after surgery for spinal metastases. Methods We retrospectively analyzed 91 patients treated at a tertiary center (2016–2018). Variables included demographics, primary tumor, extraspinal disease, metastatic epidural spinal cord compression (MESCC), pre/postoperative motor function, procedure, and reoperations. Survival groups were < 60 days, 60 days–12 months, and ≥ 12 months. Associations were tested with univariable statistics (α = 0.05). Results Of 91 patients (56% male; mean age 62.4 ± 10.8 years), 74% underwent decompression and 78% stabilization. The primary tumor was unknown in 18%; among known primaries, multiple myeloma and breast carcinoma predominated. Extraspinal metastases were absent in 77%; MESCC occurred in 68%. Survival was < 60 days in 18%, 60 days–12 months in 29%, and ≥ 12 months in 54%. Solitary and oligometastatic spinal involvement showed numerically better one-year survival compared to multiple lesions, although this difference did not reach statistical significance. Motor function improved in 16%; 14% underwent reoperation. Survival correlated with primary tumor (p = 0.004), extraspinal metastases (p = 0.001), and MESCC (p = 0.003), but not with demographics or surgical variables. In exploratory subgroups, ≥ 80% with breast carcinoma or myeloma survived ≥ 1 year, versus none with gastric or lung carcinoma. Conclusions Postoperative survival chiefly reflected tumor biology and systemic disease extent; MESCC portended poorer prognosis. Our findings suggest that the extent of vertebral involvement may have prognostic implications. Surgery achieved neurological stabilization or improvement in selected patients. Findings may inform multidisciplinary decision-making but need validation in larger cohorts.