{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:21:36Z","timestamp":1779290496128,"version":"3.51.4"},"reference-count":44,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","thespinejournalonline.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Spine Journal"],"published-print":{"date-parts":[[2026,4]]},"DOI":"10.1016\/j.spinee.2025.10.031","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:10:48Z","timestamp":1761869448000},"page":"753-766","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["Bifocal surgery for malignant spinal lesions is associated with shorter postoperative survival and higher postoperative complication rates compared to monofocal surgery"],"prefix":"10.1016","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1441-2666","authenticated-orcid":false,"given":"Julian","family":"Kylies","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Priemel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Fritsch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elias","family":"Brauneck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Kr\u00fcger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"Lenz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lennart","family":"Viezens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leon-Gordian","family":"Leonhardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.spinee.2025.10.031_bib0001","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s12885-017-3922-0","article-title":"Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States","volume":"18","author":"Hernandez","year":"2018","journal-title":"BMC Cancer"},{"issue":"1","key":"10.1016\/j.spinee.2025.10.031_bib0002","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00256-015-2268-4","article-title":"Vertebral lesion distribution in multiple myeloma\u2013assessed by reduced-dose whole-body MDCT","volume":"45","author":"Bier","year":"2016","journal-title":"Skeletal Radiol"},{"issue":"5","key":"10.1016\/j.spinee.2025.10.031_bib0003","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.3390\/curroncol28050290","article-title":"Current overview of treatment for metastatic bone disease","volume":"28","author":"Tsukamoto","year":"2021","journal-title":"Curr Oncol"},{"issue":"15","key":"10.1016\/j.spinee.2025.10.031_bib0004","doi-asserted-by":"crossref","DOI":"10.3390\/cells11152308","article-title":"Bone disease in multiple myeloma: biologic and clinical implications","volume":"11","author":"Bernstein","year":"2022","journal-title":"Cells"},{"issue":"3","key":"10.1016\/j.spinee.2025.10.031_bib0005","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1055\/s-0039-1694698","article-title":"Percutaneous interventional management of spinal metastasis","volume":"36","author":"Lee","year":"2019","journal-title":"Semin Intervent Radiol"},{"issue":"2","key":"10.1016\/j.spinee.2025.10.031_bib0006","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1038\/ncpneuro0116","article-title":"Surgery insight: current management of epidural spinal cord compression from metastatic spine disease","volume":"2","author":"Witham","year":"2006","journal-title":"Nat Clin Pract Neurol"},{"key":"10.1016\/j.spinee.2025.10.031_bib0007","article-title":"Treatment strategies for intermediate spinal instability neoplastic score (SINS 7-12) patients: a systematic review","author":"Okai","year":"2024","journal-title":"World Neurosurg"},{"issue":"6","key":"10.1016\/j.spinee.2025.10.031_bib0008","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1634\/theoncologist.2012-0293","article-title":"The NOMS framework: approach to the treatment of spinal metastatic tumors","volume":"18","author":"Laufer","year":"2013","journal-title":"Oncologist"},{"issue":"3","key":"10.1016\/j.spinee.2025.10.031_bib0009","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s00586-015-4339-6","article-title":"The Tokuhashi score: effectiveness and pitfalls","volume":"25","author":"Zoccali","year":"2016","journal-title":"Eur Spine J"},{"issue":"22","key":"10.1016\/j.spinee.2025.10.031_bib0010","doi-asserted-by":"crossref","first-page":"E1221","DOI":"10.1097\/BRS.0b013e3181e16ae2","article-title":"A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group","volume":"35","author":"Fisher","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.1016\/j.spinee.2025.10.031_bib0011","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.2147\/JPR.S315585","article-title":"The American Society of Pain and Neuroscience (ASPN) Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain","volume":"14","author":"Aman","year":"2021","journal-title":"J Pain Res"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0012","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1093\/annonc\/mdq605","article-title":"Pain management in spinal metastases: the role of percutaneous vertebral augmentation","volume":"22","author":"Kassamali","year":"2011","journal-title":"Ann Oncol"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0013","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.nec.2004.04.018","article-title":"Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients","volume":"15","author":"Perrin","year":"2004","journal-title":"Neurosurg Clin N Am"},{"issue":"11","key":"10.1016\/j.spinee.2025.10.031_bib0014","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1007\/s00586-011-1867-6","article-title":"Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients","volume":"20","author":"Quan","year":"2011","journal-title":"Eur Spine J"},{"issue":"3","key":"10.1016\/j.spinee.2025.10.031_bib0015","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3233\/THC-191727","article-title":"Quality of life and functional outcomes after surgery for spinal metastases: results of a cohort study","volume":"28","author":"Westermann","year":"2020","journal-title":"Technol Health Care"},{"issue":"3","key":"10.1016\/j.spinee.2025.10.031_bib0016","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/02688697.2015.1133802","article-title":"Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort","volume":"30","author":"Choi","year":"2016","journal-title":"Br J Neurosurg"},{"issue":"11","key":"10.1016\/j.spinee.2025.10.031_bib0017","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1097\/00007632-199211000-00022","article-title":"Posterior decompression and stabilization for multiple metastatic tumors of the spine","volume":"17","author":"Shimizu","year":"1992","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0018","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.spinee.2015.09.043","article-title":"Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS)","volume":"16","author":"Schoenfeld","year":"2016","journal-title":"Spine J"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0019","doi-asserted-by":"crossref","first-page":"E671","DOI":"10.1093\/neuros\/nyz070","article-title":"Predicting 90-day and 1-year mortality in spinal metastatic disease: development and internal validation","volume":"85","author":"Karhade","year":"2019","journal-title":"Neurosurgery"},{"issue":"3","key":"10.1016\/j.spinee.2025.10.031_bib0020","doi-asserted-by":"crossref","first-page":"262","DOI":"10.5312\/wjo.v5.i3.262","article-title":"Scoring system for prediction of metastatic spine tumor prognosis","volume":"5","author":"Tokuhashi","year":"2014","journal-title":"World J Orthop"},{"key":"10.1016\/j.spinee.2025.10.031_bib0021","series-title":"Deutsche gesellschaft f\u00fcr orthop\u00e4die und unfallchirurgie e.V. (DGOU) und deutsche wirbels\u00e4ulengesellschaft (DWG):S2k-Leitlinie wirbels\u00e4ulenmetastasen,version 1.0","year":"2024"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0022","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1007\/s00586-017-5320-3","article-title":"A systematic review of prognostic factors predicting survival in patients with spinal bone metastases","volume":"27","author":"Bollen","year":"2018","journal-title":"Eur Spine J"},{"issue":"2","key":"10.1016\/j.spinee.2025.10.031_bib0023","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/10790268.2019.1610602","article-title":"Patient outcomes and survival following surgery for spinal metastases","volume":"44","author":"Yaari","year":"2021","journal-title":"J Spinal Cord Med"},{"issue":"7","key":"10.1016\/j.spinee.2025.10.031_bib0024","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1302\/0301-620X.85B7.14201","article-title":"A population-based study of surgery for spinal metastases. Survival rates and complications","volume":"85","author":"Finkelstein","year":"2003","journal-title":"J Bone Joint Surg Br"},{"issue":"1","key":"10.1016\/j.spinee.2025.10.031_bib0025","doi-asserted-by":"crossref","first-page":"94","DOI":"10.3171\/2010.3.SPINE09202","article-title":"Diagnosis and management of metastatic spine disease. A review","volume":"13","author":"Sciubba","year":"2010","journal-title":"J Neurosurg Spine"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0026","doi-asserted-by":"crossref","first-page":"978","DOI":"10.14245\/ns.2244290.145","article-title":"Spinal metastases and the evolving role of molecular targeted therapy, chemotherapy, and immunotherapy","volume":"19","author":"Fomchenko","year":"2022","journal-title":"Neurospine"},{"issue":"3","key":"10.1016\/j.spinee.2025.10.031_bib0027","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.soncn.2017.05.012","article-title":"Pathobiology and diagnosis of multiple myeloma","volume":"33","author":"Brigle","year":"2017","journal-title":"Semin Oncol Nurs"},{"issue":"2","key":"10.1016\/j.spinee.2025.10.031_bib0028","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1007\/s11899-021-00633-5","article-title":"MRD assessment in multiple myeloma: progress and challenges","volume":"16","author":"Bertamini","year":"2021","journal-title":"Curr Hematol Malig Rep"},{"issue":"2","key":"10.1016\/j.spinee.2025.10.031_bib0029","doi-asserted-by":"crossref","first-page":"143","DOI":"10.3109\/17453679508995508","article-title":"Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients","volume":"66","author":"Bauer","year":"1995","journal-title":"Acta Orthop Scand"},{"issue":"12","key":"10.1016\/j.spinee.2025.10.031_bib0030","doi-asserted-by":"crossref","first-page":"3971","DOI":"10.1007\/s00586-015-4290-6","article-title":"A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression","volume":"25","author":"Lei","year":"2016","journal-title":"Eur Spine J"},{"issue":"1","key":"10.1016\/j.spinee.2025.10.031_bib0031","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/cncr.23150","article-title":"The first score predicting overall survival in patients with metastatic spinal cord compression","volume":"112","author":"Rades","year":"2008","journal-title":"Cancer"},{"issue":"3","key":"10.1016\/j.spinee.2025.10.031_bib0032","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/00007632-200102010-00016","article-title":"Surgical strategy for spinal metastases","volume":"26","author":"Tomita","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"10.1016\/j.spinee.2025.10.031_bib0033","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1002\/cncr.20756","article-title":"Dutch Bone Metastasis Study G. Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy","volume":"103","author":"van der Linden","year":"2005","journal-title":"Cancer"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0034","doi-asserted-by":"crossref","first-page":"527","DOI":"10.3171\/2020.12.SPINE201741","article-title":"Are spine metastasis survival scoring systems outdated and do they underestimate life expectancy? Caution in surgical recommendation guidance","volume":"35","author":"Tabourel","year":"2021","journal-title":"J Neurosurg Spine"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0035","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1097\/CORR.0000000000001081","article-title":"External validation of PATHFx Version 3.0 in patients treated surgically and nonsurgically for symptomatic skeletal metastases","volume":"478","author":"Anderson","year":"2020","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"10.1016\/j.spinee.2025.10.031_bib0036","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1002\/jor.24763","article-title":"Validation of PATHFx 2.0: an open-source tool for estimating survival in patients undergoing pathologic fracture fixation","volume":"38","author":"Overmann","year":"2020","journal-title":"J Orthop Res"},{"key":"10.1016\/j.spinee.2025.10.031_bib0037","article-title":"External validation of the PATHFx decision-support tool on Turkish patients with skeletal metastasis","author":"Ozkan","year":"2023","journal-title":"Indian J Cancer"},{"issue":"4","key":"10.1016\/j.spinee.2025.10.031_bib0038","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1097\/CORR.0000000000001148","article-title":"CORR insights(R): external validation of PATHFx Version 3.0 in patients treated surgically and nonsurgically for symptomatic skeletal metastases","volume":"478","author":"Levin","year":"2020","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.spinee.2025.10.031_bib0039","doi-asserted-by":"crossref","DOI":"10.1016\/j.jbo.2019.100225","article-title":"Prediction of survival after surgical management of femoral metastatic bone disease - A comparison of prognostic models","volume":"15","author":"Meares","year":"2019","journal-title":"J Bone Oncol"},{"issue":"9","key":"10.1016\/j.spinee.2025.10.031_bib0040","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1007\/s11999-017-5389-3","article-title":"Can A multivariate model for survival estimation in skeletal metastases (PATHFx) Be externally validated using Japanese patients?","volume":"475","author":"Ogura","year":"2017","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.spinee.2025.10.031_bib0041","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1186\/s12885-015-1396-5","article-title":"How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations","volume":"15","author":"Piccioli","year":"2015","journal-title":"BMC Cancer"},{"key":"10.1016\/j.spinee.2025.10.031_bib0042","doi-asserted-by":"crossref","DOI":"10.1016\/j.bas.2022.101669","article-title":"Predicting survival of patients with spinal metastatic disease using PathFx 3.0 - A validation study of 668 patients in Sweden","volume":"2","author":"Carrwik","year":"2022","journal-title":"Brain Spine"},{"issue":"8","key":"10.1016\/j.spinee.2025.10.031_bib0043","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1002\/jso.24620","article-title":"The SORG nomogram accurately predicts 3- and 12-months survival for operable spine metastatic disease: external validation","volume":"115","author":"Paulino Pereira","year":"2017","journal-title":"J Surg Oncol"},{"issue":"2","key":"10.1016\/j.spinee.2025.10.031_bib0044","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.semradonc.2022.11.006","article-title":"Stereotactic body radiation therapy for spinal metastases: benefits and limitations","volume":"33","author":"Guckenberger","year":"2023","journal-title":"Semin Radiat Oncol"}],"container-title":["The Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1529943025008666?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1529943025008666?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T16:17:07Z","timestamp":1774023427000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1529943025008666"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":44,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["S1529943025008666"],"URL":"https:\/\/doi.org\/10.1016\/j.spinee.2025.10.031","relation":{},"ISSN":["1529-9430"],"issn-type":[{"value":"1529-9430","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Bifocal surgery for malignant spinal lesions is associated with shorter postoperative survival and higher postoperative complication rates compared to monofocal surgery","name":"articletitle","label":"Article Title"},{"value":"The Spine Journal","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.spinee.2025.10.031","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}