Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Introduction

Metastatic spinal cord compression (MSCC) is a debilitating condition, often necessitating surgical intervention. While surgical techniques have evolved, local recurrence remains a concern. This retrospective comparative study, conducted from March 2014 to February 2020, aimed to identify factors associated with symptomatic local recurrence in MSCC patients. We analyzed surgical methods, degree of metastasis, spinal cord compression, spinal instability, pathological fractures, and radiation therapy in a cohort of 304 patients.

Materials and Methods

We retrospectively reviewed 304 MSCC patients who underwent surgery during the study period. Local recurrence rate (LRR) was assessed based on the surgical method, degree of metastasis, spinal cord compression, spinal instability, pathological fractures, and radiation therapy. Statistical analyses, including multivariate analysis, were used to determine the significance of these factors in relation to local recurrence.

Results

Of the 304 MSCC patients, 50 (16.4%) experienced local recurrence following surgery. Notably, the surgical method significantly impacted LRR (p<0.001). Among patients who underwent decompression only (n=30), 26 experienced local recurrence (86.7%). In contrast, posterior decompression and fixation (n=177) had a lower LRR, with only 9 cases (5.1%) of local recurrence, and corpectomy (n=89) also showed a lower LRR (11 cases, 12.4%) compared to decompression only.

The degree of spine metastasis was another critical factor (p=0.023). Patients with three or more spine metastases (n=60) had a 65% LRR, while those with one or two spine metastases (n=244) had a significantly lower LRR, with only 11 cases (4.5%) of local recurrence. Additionally, extraspinal bone metastasis was a related factor (p=0.001). Patients with three or more extraspinal bone metastases (n=55) exhibited a higher LRR of 40 patients (72.7%), whereas those with fewer extraspinal bone metastases (n=249) had only 10 cases of local recurrence (4.0%).

Surprisingly, preoperative and postoperative radiotherapy did not show a significant correlation with local recurrence in our study population. However, the presence of a pathologic fracture was strongly related to local recurrence. Among patients with pathologic fractures (n=142), 45 experienced local recurrence (31.7%), while in the absence of fractures (n=162), only 5 cases (3.1%) of local recurrence were observed.

Conclusion

Our study identifies key factors contributing to symptomatic local recurrence in MSCC patients. The choice of surgical method, degree of spine metastasis, and the presence of extraspinal bone metastasis significantly impact LRR. Posterior decompression and fixation prove to be an effective approach in reducing local recurrence, emphasizing the importance of spinal stability. Conversely, a high degree of metastasis and the presence of pathologic fractures are associated with an elevated LRR. These findings can guide surgical decision-making and highlight the importance of considering individual patient characteristics when managing MSCC.

[Figure] Kaplan-Meier curve for the local recurrence