{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T20:30:21Z","timestamp":1770496221196,"version":"3.49.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>In the absence of spinal cord compression, it is unclear if surgery is more effective than radiation treatment for improving functional outcomes in metastatic spinal tumor patients with potentially unstable spines. The authors compared functional status outcomes assessed with Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group (ECOG) scores after surgery or radiation in patients without spinal cord compression with Spine Instability Neoplastic Score (SINS) values of 7\u201312 indicating possible instability (SINS 7\u201312).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective review was performed of patients with metastatic spinal tumor SINS values of 7\u201312 at a single institution between 2004 and 2014. Patients were divided into two different groups: 1) those treated with surgery and 2) those treated with radiation. Baseline clinical characteristics were measured, and KPS and ECOG scores were obtained pre- and postradiation or postsurgery. The paired, nonparametric Wilcoxon signed-rank test and ordinal logistic regression analysis were used for statistical analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 162 patients met inclusion criteria; 63 patients were treated operatively and 99 patients were treated with radiation. The mean follow-up was 1.9 years, with a median of 1.1 years for the surgical cohort (ranging from 2.5 months to 13.8 years) and a mean of 2 years with a median of 0.8 years for the radiation cohort (ranging from 2 months to 9.3 years). After covariates were accounted for, the average posttreatment changes in KPS scores in the surgical cohort were 7.46 \u00b1 17.3 and in the radiation cohort were \u22122 \u00b1 13.6 (p = 0.045). No significant difference was observed in ECOG scores. KPS scores improved postoperatively in 60.3% of patients in the surgical group and postradiation in 32.3% of patients in the radiation cohort (p &lt; 0.001). Subanalysis within the radiation cohort revealed no differences in fracture rates or local control between patients treated with external-beam radiation therapy versus stereotactic body radiation therapy. In patients initially treated with radiation, 21.2% eventually developed compression fractures at a treated level. Five of the 99 patients in the radiation cohort\u2014all of whom had a fracture\u2014eventually underwent either methyl methacrylate augmentation or instrumented fusion.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Patients with SINS values of 7\u201312 who underwent surgery had greater improvement in KPS scores\u2014but not in ECOG scores\u2014than patients undergoing radiation alone. In patients treated with radiation, treatment was converted to a procedural intervention such as surgery only in patients who sustained fractures. Of the patients with fractures after radiation (21 of 99), 5 patients underwent an invasive procedure and 16 did not.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.3.spine221120","type":"journal-article","created":{"date-parts":[[2023,5,6]],"date-time":"2023-05-06T15:54:33Z","timestamp":1683388473000},"page":"287-294","source":"Crossref","is-referenced-by-count":8,"title":["Does surgery for metastatic spinal tumors improve functional outcomes in patients without spinal cord compression but with potentially unstable spines (SINS 7\u201312)?"],"prefix":"10.3171","volume":"39","author":[{"given":"Enrique","family":"Vargas","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saman","family":"Shabani","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Park","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alma","family":"Rechav Ben-Natan","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua J.","family":"Rivera","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Huang","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sigurd","family":"Berven","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steve","family":"Braunstein","sequence":"additional","affiliation":[{"name":"Radiation Oncology, University of California, San Francisco, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Department of Neurological Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"9486","key":"b1","series-title":"Lancet","first-page":"643","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial","volume":"366","author":"Patchell RA","year":"2005","unstructured":"Patchell RA, Tibbs PA, Regine WF,  Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643\u2013648.16112300"},{"issue":"6","key":"b2","series-title":"Oncologist","first-page":"744","article-title":"The NOMS framework: approach to the treatment of spinal metastatic tumors","volume":"18","author":"Laufer I","year":"2013","unstructured":"Laufer I, Rubin DG, Lis E,  The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744\u2013751."},{"issue":"22","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"E1221","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 CG","year":"2010","unstructured":"Fisher CG, DiPaola CP, Ryken TC,  A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976).2010;35(22):E1221\u2013E1229."},{"issue":"3","key":"b4","series-title":"J Craniovertebr Junction Spine","first-page":"287","article-title":"Outcomes and survival of spinal metastasis with epidural compression","volume":"12","author":"Candido PBM","year":"2021","unstructured":"Candido PBM, Peria FM, Pinheiro RP, Costa HRT, Defino HLA. Outcomes and survival of spinal metastasis with epidural compression. J Craniovertebr Junction Spine. 2021;12(3):287\u2013293.34728996"},{"issue":"5","key":"b5","series-title":"Curr Oncol","first-page":"3891","article-title":"Spinal manifestation of malignant primary (PLB) and secondary bone lymphoma (SLB)","volume":"28","author":"Barz M","year":"2021","unstructured":"Barz M, Aftahy K, Janssen I,  Spinal manifestation of malignant primary (PLB) and secondary bone lymphoma (SLB). Curr Oncol. 2021;28(5):3891\u20133899.34677250"},{"key":"b6","series-title":"J Clin Imaging Sci","first-page":"21","article-title":"Spinal tumors and tumor-like masses: relevance of initial imaging, Karnofsky Performance Status, age, location, and cord edema","volume":"9","author":"Gupta SK","year":"2019","unstructured":"Gupta SK, Gahlot S, Singh R, Singh V. Spinal tumors and tumor-like masses: relevance of initial imaging, Karnofsky Performance Status, age, location, and cord edema. J Clin Imaging Sci. 2019;9:21.31448172"},{"issue":"12","key":"b7","series-title":"Oncologist","first-page":"e1460","article-title":"Comparing physician and nurse Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ratings as predictors of clinical outcomes in patients with cancer","volume":"24","author":"Neeman E","year":"2019","unstructured":"Neeman E, Gresham G, Ovasapians N,  Comparing physician and nurse Eastern Cooperative Oncology Group Performance Status (ECOG-PS) ratings as predictors of clinical outcomes in patients with cancer. Oncologist. 2019;24(12):e1460\u2013e1466.31227648"},{"issue":"5","key":"b8","series-title":"Global Spine J","first-page":"460","article-title":"Systematic review of the outcomes of surgical treatment of prostate metastases to the spine","volume":"7","author":"Clarke MJ","year":"2017","unstructured":"Clarke MJ, Molina CA, Fourney DR,  Systematic review of the outcomes of surgical treatment of prostate metastases to the spine. Global Spine J. 2017;7(5):460\u2013468."},{"issue":"2","key":"b9","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Decompression surgery for spinal metastases: a systematic review","volume":"41","author":"Bakar D","year":"2016","unstructured":"Bakar D, Tanenbaum JE, Phan K,  Decompression surgery for spinal metastases: a systematic review. Neurosurg Focus. 2016;41(2):E2.27476844"},{"key":"b10","series-title":"JCO Clin Cancer Inform","first-page":"221","article-title":"OncoTree: A cancer classification system for precision oncology","volume":"5","author":"Kundra R","year":"2021","unstructured":"Kundra R, Zhang H, Sheridan R,  OncoTree: A cancer classification system for precision oncology. 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J Neurosurg Spine. 2010;13(3):324\u2013328.20809724"},{"issue":"6","key":"b15","series-title":"Eur Spine J","first-page":"1402","article-title":"Independent predictors of complication following surgery for spinal metastasis","volume":"22","author":"Lau D","year":"2013","unstructured":"Lau D, Leach MR, Than KD, Ziewacz J, La Marca F, Park P. Independent predictors of complication following surgery for spinal metastasis. Eur Spine J. 2013;22(6):1402\u20131407.23392558"},{"issue":"3","key":"b16","series-title":"Cancer","first-page":"625","article-title":"National inpatient complications and outcomes after surgery for spinal metastasis from 1993-2002","volume":"110","author":"Patil CG","year":"2007","unstructured":"Patil CG, Lad SP, Santarelli J, Boakye M. National inpatient complications and outcomes after surgery for spinal metastasis from 1993-2002. Cancer. 2007;110(3):625\u2013630.17577227"},{"issue":"18","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"1943","article-title":"Complication, survival rates, and risk factors of surgery for metastatic disease of the spine","volume":"24","author":"Wise JJ","year":"1999","unstructured":"Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT. Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine (Phila Pa 1976). 1999;24(18):1943\u20131951.10515021"},{"issue":"6","key":"b18","series-title":"PLoS One","first-page":"e98797","article-title":"Perioperative complications of total en bloc spondylectomy: adverse effects of preoperative irradiation","volume":"9","author":"Yokogawa N","year":"2014","unstructured":"Yokogawa N, Murakami H, Demura S,  Perioperative complications of total en bloc spondylectomy: adverse effects of preoperative irradiation. PLoS One. 2014;9(6):e98797.24893004"},{"issue":"1","key":"b19","series-title":"Clin Spine Surg","first-page":"4","article-title":"Perioperative complications of spinal metastases surgery","volume":"30","author":"Luksanapruksa P","year":"2017","unstructured":"Luksanapruksa P, Buchowski JM, Zebala LP, Kepler CK, Singhatanadgige W, Bumpass DB. Perioperative complications of spinal metastases surgery. Clin Spine Surg. 2017;30(1):4\u201313.27984252"},{"issue":"4","key":"b20","series-title":"J Neurosurg Spine","first-page":"529","article-title":"Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?","volume":"33","author":"Massaad E","year":"2020","unstructured":"Massaad E, Hadzipasic M, Alvarez-Breckenridge C,  Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?. J Neurosurg Spine. 2020;33(4):529\u2013539."},{"issue":"26","key":"b21","series-title":"Spine (Phila Pa 1976)","first-page":"2168","article-title":"Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: a new score","volume":"37","author":"Crnalic S","year":"2012","unstructured":"Crnalic S, L\u00f6fvenberg R, Bergh A, Widmark A, Hildingsson C. Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: a new score. Spine (Phila Pa 1976). 2012;37(26):2168\u20132176.22648028"},{"issue":"8","key":"b22","series-title":"Oncologist","first-page":"972","article-title":"Prospective evaluation of the relationship between mechanical stability and response to palliative radiotherapy for symptomatic spinal metastases","volume":"22","author":"van der Velden JM","year":"2017","unstructured":"van der Velden JM, Versteeg AL, Verkooijen HM,  Prospective evaluation of the relationship between mechanical stability and response to palliative radiotherapy for symptomatic spinal metastases. Oncologist. 2017;22(8):972\u2013978.28469043"},{"issue":"11","key":"b23","series-title":"J Clin Oncol","first-page":"1423","article-title":"Palliative radiotherapy trials for bone metastases: a systematic review","volume":"25","author":"Chow E","year":"2007","unstructured":"Chow E, Harris K, Fan G, Tsao M, Sze WM. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol. 2007;25(11):1423\u20131436.17416863"},{"issue":"2","key":"b24","series-title":"Radiother Oncol","first-page":"274","article-title":"Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy","volume":"128","author":"Sprave T","year":"2018","unstructured":"Sprave T, Verma V, F\u00f6rster R,  Randomized phase II trial evaluating pain response in patients with spinal metastases following stereotactic body radiotherapy versus three-dimensional conformal radiotherapy. 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