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Patients were divided into the SSVPI group (Separation surgery + vertebroplasty +\n                      <jats:sup>125<\/jats:sup>\n                      I seeds implantation, n=48) and the control group (Decompression surgery involving separation, reconstruction, and fixation, n=48). At postoperative follow-up (1 week to 12 months), spinal cord function, pain, performance status, muscle strength, and health-related quality of life were assessed. Complications were recorded, and overall survival, progression-free survival, and local control were analyzed using Kaplan-Meier curves.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All 96 patients underwent the surgery successfully. The baseline characteristics showed no significant between the two groups. The SSVPI group demonstrated superior outcomes, with better neurological recovery(Higher International Standards for Neurological Classification of Spinal Cord Injury grade D improvement; &gt;40% at 1\/3\/6 months, P&lt;0.005). Pain relief (Faster visual analog scale pain score reduction;&gt;60% decline within 2 months, P&lt;0.001), and improved performance status (Earlier ECOG\/KPS improvement;\u226575% by 2 weeks). Quality of life, assessed by Quality of Life Questionnaire-Core 30 scores increased by 18.6 points at 3 months (P\u22640.003).The SSVPI group also experienced longer median overall survival (20 vs. 12 months, P=0.026), progression-free survival (12 vs. 8 months), and local control (all P&lt;0.05). The SSVPI group primarily experienced minor bone cement leakage (10.42%)), whereas the control group experienced complications predominantly related to tumor progression-associated secondary spinal cord compression (3 cases, 6.25%) and radiation therapy-related adverse events (total incidence: 39.6%), including radiation dermatitis (18.75%), osteonecrosis (16.67%), and spinal cord injury (4.17%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      SSVPI is an optimized treatment for lung adenocarcinoma-related MESCC.\u00a0It provides immediate spinal cord decompression and stabilization, concurrent intraoperative\n                      <jats:sup>125<\/jats:sup>\n                      I seeds implantation for early and sustained radiotherapy, and avoids delayed postoperative radiation and complications associated with external beam therapy. This approach enhances local tumor control while preserving neurological function and improving quality of life.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12957-025-04148-8","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T04:04:27Z","timestamp":1765512267000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical study of separation surgery combined with intraoperative vertebroplasty and 125I seeds implantation for spinal metastases from lung adenocarcinoma with epidural spinal cord compression"],"prefix":"10.1186","volume":"24","author":[{"given":"Ya","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yihao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabil Zia","family":"UI Haq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhou","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dachang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongqi","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiquan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linhao","family":"Cai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongpu","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zuozhang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"issue":"1","key":"4148_CR1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.path.2019.11.002","volume":"13","author":"R Ruiz-Cordero","year":"2020","unstructured":"Ruiz-Cordero R, Devine WP. 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