Complication, survival rates, and risk factors of surgery for metastatic disease of the spine

Study Design. The risk factors for complications and complication and survi val rates in patients with metastatic disease of the spine were reviewed. A retrospective study was performed. Objectives. To determine the surgical complication and survival rates of pa tients with metastatic disease of the spine and risk factors for complicati on occurrence. Summary of Background Data. The role of surgical intervention for patients with metastatic disease of the spine has been controversial. Several risk f actors for surgical complications have been identified. Short survival time s and high complication rates have failed to justify surgical intervention in many cases. Methods. Patients (n = 80) undergoing surgical treatment for metastatic dis ease of the spine were reviewed. Surgical indications included progressive neurologic deficit, neurologic deficit failing to respond to, or progressin g after, radiation treatment; intractable pain; radioresistant tumors; or t he need for histologic diagnosis. Patients underwent anterior, posterior, o r combined decompression and stabilization procedures. Neurologic examinati on was recorded before surgery, postoperative period, and at latest follow- up. Complication and survival rates were calculated. Several variables were era mined for risk of complication. Results. The mean age at time of surgery was 55.6 years (range, 20-84 years ). Mean survival time after the diagnosis of spinal metastasis was 26.0 mon ths (range, 1-107.25 months). Mean survival time after surgery was 15.9 mon ths (range, 0.25-55.5 months). Sixty-five patients showed no change in Fran kel grade, 19 improved one Frankel grade, and 1 deteriorated one Frankel gr ade; 1 patient had paraplegia. Thirty-five complications occurred in 20 pat ients (25.0%). Ten patients (12.5%) had multiple complications accounting f or 23 of the 35 postoperative problems (65.7%). Sixty patients had no surgi cal complications (75%). There were no intraoperative deaths. Conclusions. The likelihood that a complication occurred was significantly related to Harrington classifications demonstrating significant neurologic deficits and the use of preoperative radiation therapy. In general, Harring ton classifications with neurologic deficits and lower Frankel grades befor e and after surgery were associated with an increased risk of complication. Overall, the major complication rate was relatively low, and minor complic ations were successfully treated with minimal morbidity. The relatively lon g survival time after spinal surgery in this group of patients justifies su rgical treatment for met astatic disease. Most complications occurred in a: small percentage of patients. To minimize complications, pati ients must be carefully selected based on expected length of survival, the use of radiat ion therapy, presence of neurologic deficit, and impending spinal instabili ty or collapse caused by bone destruction.