Factors Associated with Selection for Surgery or Non-operative Care in Patients Treated for Spinal Metastases

Background: Surgery is increasingly accepted as a primary option for the treatment of patients with spinal metastases. Such approaches carry elevated risk of complications and early mortality and these risks must be balanced against potential for long-term benefit and recovery. At present, factors associated with a decision for surgery or non-operative care remain poorly described.

Methods: We reviewed the cases of more than 400 patients (age 40-80) who presented for primary treatment of spinal metastases at Brigham and Women`s Hospital and Massachusetts General Hospital. Charts were abstracted to identify the primary treatment modality in the first eight weeks following presentation as well as sociodemographic and clinical characteristics of the individuals treated. Factors associated with a decision for surgery within eight weeks of presentation were evaluated using multivariable logistic regression tests.

Results: We identified 418 patients for inclusion. The most common primary tumor was lung cancer, followed by breast cancer. Surgery was performed in 104 cases (25%). Mortality occurred in 99 individuals (29%) at two months after presentation. Ambulatory status at presentation was associated with decision for surgery and survival. Patient age, more than 5 comorbidities, liver metastases and serum albumin were associated with survival

Conclusion: This study identifies a number of important predictors that appear to be associated with a decision for surgery in the care of patients with spinal metastases. These factors are not synonymous with those that influence survival beyond the post-surgical period.