{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T16:15:32Z","timestamp":1788970532174,"version":"build-2803163510"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2017,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The purpose of this study was to determine the rate of symptomatic vertebral body compression fractures (VCFs) requiring kyphoplasty or surgery in patients treated with 24-Gy single-fraction stereotactic radiosurgery (SRS).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This retrospective analysis included all patients who had been treated with 24-Gy, single-fraction, image-guided intensity-modulated radiation therapy for histologically confirmed solid tumor metastases over an 8-year period (2005\u20132013) at Memorial Sloan Kettering Cancer Center. Charts and imaging studies were reviewed for post-SRS kyphoplasty or surgery for mechanical instability. A Spinal Instability Neoplastic Score (SINS) was calculated for each patient both at the time of SRS and at the time of intervention for VCF.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Three hundred twenty-three patients who had undergone single-fraction SRS between C-1 and L-5 were included in this analysis. The cumulative incidence of VCF 5 years after SRS was 7.2% (95% CI 4.1\u201310.2), whereas that of death following SRS at the same time point was 82.5% (95% CI 77.5\u201387.4). Twenty-six patients with 36 SRS-treated levels progressed to symptomatic VCF requiring treatment with kyphoplasty (6 patients), surgery (10 patients), or both (10 patients). The median time to symptomatic VCF was 13 months. Seven patients developed VCF at 11 levels adjacent to the SRS-treated level. Fractured levels had no evidence of tumor progression. The median SINS changed from 6.5 at SRS (interquartile range [IQR] 4.3\u20138.8) to 11.5 at stabilization (IQR 9\u201313). In patients without prior stabilization at the level of SRS, there was an association between the SINS and the time to fracture.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Five years after ablative single-fraction SRS to spinal lesions, the cumulative incidence of symptomatic VCF at the treated level without tumor recurrence was 7.2%. Higher SINSs at the time of SRS correlated with earlier fractures.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.10.focus16359","type":"journal-article","created":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T03:37:18Z","timestamp":1483241838000},"page":"E8","source":"Crossref","is-referenced-by-count":55,"title":["Frequency of symptomatic vertebral body compression fractures requiring intervention following single-fraction stereotactic radiosurgery for spinal metastases"],"prefix":"10.3171","volume":"42","author":[{"given":"Michael S.","family":"Virk","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Han","sequence":"additional","affiliation":[{"name":"Radiation Oncology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne S.","family":"Reiner","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily A.","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Lis","sequence":"additional","affiliation":[{"name":"Radiology, Memorial Sloan Kettering Cancer Center;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Yamada","sequence":"additional","affiliation":[{"name":"Radiation Oncology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bilsky","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Laufer","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Department of Neurological Surgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16359","series-title":"J Neurosurg Spine","first-page":"430","article-title":"Radiation-induced vertebral compression fracture following spine stereotactic radiosurgery: clinicopathological correlation","volume":"18","author":"Al-Omair","year":"2013"},{"key":"b2-focus16359","series-title":"Lancet Oncol","first-page":"225","article-title":"Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial","volume":"12","author":"Berenson","year":"2011"},{"key":"b3-focus16359","series-title":"J Neurosurg Spine","first-page":"379","article-title":"Vertebral compression fracture risk after stereotactic body radiotherapy for spinal metastases","volume":"16","author":"Boehling","year":"2012"},{"key":"b4-focus16359","series-title":"Int J Radiat Oncol Biol Phys","first-page":"e597","article-title":"International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery","volume":"83","author":"Cox","year":"2012"},{"key":"b5-focus16359","series-title":"Int J Radiat Oncol Biol Phys","first-page":"e343","article-title":"Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors","volume":"84","author":"Cunha","year":"2012"},{"key":"b6-focus16359","series-title":"Clinics (Sao Paulo)","first-page":"101","article-title":"Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions","volume":"71","author":"de Moraes","year":"2016"},{"key":"b7-focus16359","series-title":"PLoS One","first-page":"e64952","article-title":"Altered composition of bone as triggered by irradiation facilitates the rapid erosion of the matrix by both cellular and physicochemical processes","volume":"8","author":"Green","year":"2013"},{"key":"b8-focus16359","series-title":"J Neurosurg Spine","first-page":"928","article-title":"Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation","volume":"24","author":"Jawad","year":"2016"},{"key":"b9-focus16359","series-title":"J Neurooncol","first-page":"509","article-title":"Can the spinal instability neoplastic score prior to spinal radiosurgery predict compression fractures following stereotactic spinal radiosurgery for metastatic spinal tumor?: a post hoc analysis of prospective phase II single-institution trials","volume":"126","author":"Lee","year":"2016"},{"key":"b10-focus16359","series-title":"Spine J","first-page":"2434","article-title":"Improvement in pain after lumbar surgery in cancer patients with mechanical radiculopathy","volume":"14","author":"Moliterno","year":"2014"},{"key":"b11-focus16359","series-title":"Spine J","first-page":"1609","article-title":"Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability","volume":"15","author":"Moussazadeh","year":"2015"},{"key":"b12-focus16359","series-title":"Oral Surg Oral Med Oral 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Phys","first-page":"e343","article-title":"Vertebral compression fracture (VCF) after spine stereotactic body radiation therapy (SBRT): analysis of predictive factors","volume":"84","author":"Cunha","year":"2012"},{"key":"b6-focus16359","series-title":"Clinics (Sao Paulo)","first-page":"101","article-title":"Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions","volume":"71","author":"de Moraes","year":"2016"},{"key":"b7-focus16359","series-title":"PLoS One","first-page":"e64952","article-title":"Altered composition of bone as triggered by irradiation facilitates the rapid erosion of the matrix by both cellular and physicochemical processes","volume":"8","author":"Green","year":"2013"},{"key":"b8-focus16359","series-title":"J Neurosurg Spine","first-page":"928","article-title":"Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation","volume":"24","author":"Jawad","year":"2016"},{"key":"b9-focus16359","series-title":"J Neurooncol","first-page":"509","article-title":"Can the spinal instability neoplastic score prior to spinal radiosurgery predict compression fractures following stereotactic spinal radiosurgery for metastatic spinal tumor?: a post hoc analysis of prospective phase II single-institution trials","volume":"126","author":"Lee","year":"2016"},{"key":"b10-focus16359","series-title":"Spine J","first-page":"2434","article-title":"Improvement in pain after lumbar surgery in cancer patients with mechanical radiculopathy","volume":"14","author":"Moliterno","year":"2014"},{"key":"b11-focus16359","series-title":"Spine J","first-page":"1609","article-title":"Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability","volume":"15","author":"Moussazadeh","year":"2015"},{"key":"b12-focus16359","series-title":"Oral Surg Oral Med Oral 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Oncol","first-page":"76","article-title":"RTOG 0631 phase 2\/3 study of image guided stereotactic radiosurgery for localized 1\u20133 spine metastases: phase 2 results","volume":"4","author":"Ryu","year":"2014"},{"key":"b17-focus16359","series-title":"J Clin Oncol","first-page":"3426","article-title":"Vertebral compression fracture after spine stereotactic body radiotherapy: a multi-institutional analysis with a focus on radiation dose and the spinal instability neoplastic score","volume":"31","author":"Sahgal","year":"2013"},{"key":"b18-focus16359","series-title":"J Orthop Sci","first-page":"203","article-title":"The route of metastatic vertebral tumors extending to the adjacent vertebral body: a histological study","volume":"16","author":"Sasagawa","year":"2011"},{"key":"b19-focus16359","series-title":"Strahlenther Onkol","first-page":"233","article-title":"Osteoradionecrosis of the mandibula in patients treated with different 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