Clinical Outcomes and Safety of a Triple-Modality Approach Combining Decompression, Vertebral Augmentation, and Radiotherapy for Thoracolumbar Metastatic Tumors With Neurological Involvement

Jian-Min Wang,1,2,* Pei-Sheng Liu,1,2,* De-Xin Zou,1,2 Jian-Feng Zhang,1,2 Tao Sun,2 Jun-Jie Jiang,2 Jian-Qing Liu,1,2 Wei Du1,2 1Department of Spine Surgery, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, 264003, People’s Republic of China; 2Yantai Key Laboratory of Repair and Reconstruction of Bone & Joint, Yantaishan Hospital Affiliated to Binzhou Medical University, Yantai, Shandong, 264003, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Du, Department of Spine Surgery, Yantaishan Hospital Affiliated to Binzhou Medical University, No. 10087, Keji Avenue, Laishan District, Yantai, 264003, People’s Republic of China, Tel +86 0535 6863895, Fax +86 0535 6863937, Email [email protected]: To evaluate the clinical efficacy and safety of a triple-modality therapy—decompression, vertebral augmentation, and radiotherapy—in patients with thoracolumbar metastatic tumors accompanied by neurological injury.Methods: A retrospective analysis was performed involving 86 patients who underwent treatment for thoracolumbar metastatic tumors with neurological involvement between January 2017 and December 2022. Participants were categorized into two groups: a control group (n = 45) that received conventional separation surgery combined with pedicle screw fixation, and an intervention group (n = 41) that received the triple-modality therapy. This therapeutic approach comprised (1) decompression through separation surgery, which involved excision of tumor tissue adjacent to the dura mater to establish a protective margin; (2) vertebral augmentation via bone cement injection into the affected vertebrae, along with bone cement-augmented pedicle screw fixation; and (3) stereotactic radiosurgery. Postoperative outcomes, including pain intensity, neurological function, and quality of life, were assessed and compared between groups.Results: The intervention group experienced significantly longer surgical durations but demonstrated reduced intraoperative blood loss compared with the control group (p < 0.05). Both groups demonstrated improvements in pain levels, neurological function, and quality of life following surgery. However, the intervention group exhibited significantly lower visual analogue scale scores at the final follow-up (p < 0.05). Additionally, significant improvements were observed in the Frankel grade and Karnofsky Performance Status scores within the intervention group compared with the control group at the final follow-up (both p < 0.05). The Cobb angle in the control group demonstrated a significant increase from 1 week postoperatively to the final follow-up (p < 0.05).Conclusion: The decompression-vertebral augmentation-radiotherapy triple-modality therapy demonstrated efficacy in alleviating pain, promoting neurological recovery, and improving quality of life while maintaining spinal stability and a low rate of complications.Keywords: neurological injury, separation surgery, stereotactic radiosurgery, thoracolumbar metastatic tumors, vertebral augmentation