{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:31Z","timestamp":1780736491689,"version":"3.54.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Surgery is typically indicated for mechanical pain in metastatic spine disease or severe neurological compromise, but how radicular pain responds to oncological treatment is not well described. The primary aim of this study was to describe how radicular pain responds to oncological treatment, while secondary aims included pain outcomes between patients with mechanical and tumoral pain and motor improvement in patients with weakness due to nerve root compression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients treated with surgery and\/or radiotherapy for spinal metastases were identified from an international multicenter prospective cohort. The primary outcome was the numeric rating scale (NRS) score for pain at 3 months posttreatment. Motor recovery from radicular compression in patients with myotomic weakness and low-grade epidural compression was also analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 284 patients, 129 (45%) had radicular pain \u00b1 axial pain and 155 (55%) had axial pain alone. The two groups did not significantly differ in age, comorbidities, tumor characteristics, or treatment. Two hundred two patients (71%) underwent surgery \u00b1 radiotherapy, whereas 82 (29%) had radiotherapy alone. The NRS score of patients with radicular pain improved from 6.7 to 3.4 at 3 months, a statistically significantly higher magnitude than in patients with isolated axial pain (p = 0.021). The NRS score at 3 months was similar for both groups (p = 0.876). Patients with radicular pain experienced a larger improvement with surgery compared with radiotherapy alone (p = 0.007) but had higher pretreatment pain (mean NRS score 7.0 vs 5.6, p = 0.013). Twenty-three patients identified with radicular\/myotomic weakness (mean American Spinal Injury Association score 96.3 \u00b1 3.2) at baseline improved 2.1 \u00b1 3.8 points at 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The magnitude of pain improvement for patients with radicular pain following surgery and radiotherapy for metastatic spine disease is higher than for patients with axial pain alone. Surgery is associated with a larger improvement in radicular pain than radiotherapy alone. These results will allow clinicians to tailor treatment options for patients with metastatic spine disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.focus24915","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:39:30Z","timestamp":1746081570000},"page":"E14","source":"Crossref","is-referenced-by-count":2,"title":["Impact of surgery and radiation on radicular pain and myotomic weakness in patients with metastatic spine disease"],"prefix":"10.3171","volume":"58","author":[{"given":"Arthur R.","family":"Bartolozzi","sequence":"first","affiliation":[{"name":"Division of Spine Surgery, University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ori","family":"Barzilai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya","family":"Laufer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Sahgal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence D.","family":"Rhines","sequence":"additional","affiliation":[{"name":"Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Sciubba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aron","family":"Lazary","sequence":"additional","affiliation":[{"name":"National Center for Spinal Disorders, Budapest, Hungary;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael H.","family":"Weber","sequence":"additional","affiliation":[{"name":"Combined Orthopedic and Neurosurgery Spine Program, McGill University Health Centre, Montreal, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Schuster","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Penn Presbyterian Hospital, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Boriani","sequence":"additional","affiliation":[{"name":"University of Bologna, Contract Professor of Spine Surgery, Post Graduate School of Orthopedics at ISCCS Istituto Rizzoli, Bologna, Italia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Bettegowda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Illinois Urbana-Champaign, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle J.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles G.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bilsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Dea","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"J Am Acad Orthop Surg","first-page":"587","article-title":"Metastatic disease of the spine","volume":"14","author":"White AP","year":"2006","unstructured":"White AP, Kwon BK, Lindskog DM, Friedlaender GE, Grauer JN. Metastatic disease of the spine. J Am Acad Orthop Surg. 2006;14(11):587\u2013598."},{"issue":"4","key":"b2","series-title":"JAMA Oncol","first-page":"567","article-title":"Stereotactic ablative radiotherapy for the management of spinal metastases: a review","volume":"6","author":"Glicksman RM","year":"2020","unstructured":"Glicksman RM, Tjong MC, Neves-Junior WFP,  Stereotactic ablative radiotherapy for the management of spinal metastases: a review. JAMA Oncol. 2020;6(4):567\u2013577."},{"issue":"12","key":"b3","series-title":"Lancet Oncol","first-page":"e720","article-title":"An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report","volume":"18","author":"Spratt DE","year":"2017","unstructured":"Spratt DE, Beeler WH, de Moraes FY,  An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. Lancet Oncol. 2017;18(12):e720\u2013e730."},{"issue":"3","key":"b4","series-title":"Int J Oncol","first-page":"533","article-title":"Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review","volume":"36","author":"Itshayek E","year":"2010","unstructured":"Itshayek E, Yamada J, Bilsky M,  Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol. 2010;36(3):533\u2013544."},{"issue":"16","key":"b5","series-title":"J Clin Oncol","first-page":"1647","article-title":"Pain and nociception: mechanisms of cancer-induced bone pain","volume":"32","author":"Falk S","year":"2014","unstructured":"Falk S, Dickenson AH. Pain and nociception: mechanisms of cancer-induced bone pain. 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J Clin Oncol. 2011;29(22):3072\u20133077."},{"issue":"3","key":"b7","series-title":"J Clin Oncol","first-page":"268","article-title":"Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study","volume":"34","author":"Fehlings MG","year":"2016","unstructured":"Fehlings MG, Nater A, Tetreault L,  Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study. J Clin Oncol. 2016;34(3):268\u2013276."},{"issue":"5","key":"b8","series-title":"J Neurosurg Spine","first-page":"550","article-title":"Surgical management of metastatic disease of the lumbar spine: experience with 139 patients","volume":"2","author":"Holman PJ","year":"2005","unstructured":"Holman PJ, Suki D, McCutcheon I, Wolinsky JP, Rhines LD, Gokaslan ZL. Surgical management of metastatic disease of the lumbar spine: experience with 139 patients. J Neurosurg Spine. 2005;2(5):550\u2013563."},{"issue":"2","key":"b9","series-title":"J Spine Surg","first-page":"372","article-title":"Endoscopic surgical treatment for symptomatic spinal metastases in long-term cancer survivors","volume":"6","author":"Telfeian AE","year":"2020","unstructured":"Telfeian AE, Oyelese A, Fridley J, Doberstein C, Gokaslan ZL. Endoscopic surgical treatment for symptomatic spinal metastases in long-term cancer survivors. J Spine Surg. 2020;6(2):372\u2013382."},{"issue":"11","key":"b10","series-title":"J Am Acad Orthop Surg Glob Res Rev","first-page":"e22.00201","article-title":"Posterior endoscopic cervical decompression in metastatic cervical spine tumors: an alternative to palliative surgery","volume":"6","author":"Kotheeranurak V","year":"2022","unstructured":"Kotheeranurak V, Jitpakdee K, Pornmeechai Y,  Posterior endoscopic cervical decompression in metastatic cervical spine tumors: an alternative to palliative surgery. J Am Acad Orthop Surg Glob Res Rev. 2022;6(11):e22.00201."},{"issue":"5","key":"b11","series-title":"Neurosurgery","first-page":"1148","article-title":"Patient-reported and clinical outcomes of surgically treated patients with symptomatic spinal metastases: results from Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO), a prospective, multi-institutional and international study","volume":"95","author":"Barzilai O","year":"2024","unstructured":"Barzilai O, Sahgal A, Rhines LD,  Patient-reported and clinical outcomes of surgically treated patients with symptomatic spinal metastases: results from Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO), a prospective, multi-institutional and international study. Neurosurgery. 2024;95(5):1148\u20131157."},{"issue":"2","key":"b12","series-title":"Neurosurgery","first-page":"303","article-title":"Metastatic spine disease: should patients with short life expectancy be denied surgical care? An international retrospective cohort study","volume":"87","author":"Dea N","year":"2020","unstructured":"Dea N, Versteeg AL, Sahgal A,  Metastatic spine disease: should patients with short life expectancy be denied surgical care? An international retrospective cohort study. Neurosurgery. 2020;87(2):303\u2013311."},{"issue":"11","key":"b1","series-title":"J Am Acad Orthop Surg","first-page":"587","article-title":"Metastatic disease of the spine","volume":"14","author":"White AP","year":"2006","unstructured":"White AP, Kwon BK, Lindskog DM, Friedlaender GE, Grauer JN. Metastatic disease of the spine. J Am Acad Orthop Surg. 2006;14(11):587\u2013598."},{"issue":"4","key":"b2","series-title":"JAMA Oncol","first-page":"567","article-title":"Stereotactic ablative radiotherapy for the management of spinal metastases: a review","volume":"6","author":"Glicksman RM","year":"2020","unstructured":"Glicksman RM, Tjong MC, Neves-Junior WFP,  Stereotactic ablative radiotherapy for the management of spinal metastases: a review. JAMA Oncol. 2020;6(4):567\u2013577."},{"issue":"12","key":"b3","series-title":"Lancet Oncol","first-page":"e720","article-title":"An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report","volume":"18","author":"Spratt DE","year":"2017","unstructured":"Spratt DE, Beeler WH, de Moraes FY,  An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. Lancet Oncol. 2017;18(12):e720\u2013e730."},{"issue":"3","key":"b4","series-title":"Int J Oncol","first-page":"533","article-title":"Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review","volume":"36","author":"Itshayek E","year":"2010","unstructured":"Itshayek E, Yamada J, Bilsky M,  Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol. 2010;36(3):533\u2013544."},{"issue":"16","key":"b5","series-title":"J Clin Oncol","first-page":"1647","article-title":"Pain and nociception: mechanisms of cancer-induced bone pain","volume":"32","author":"Falk S","year":"2014","unstructured":"Falk S, Dickenson AH. Pain and nociception: mechanisms of cancer-induced bone pain. J Clin Oncol. 2014;32(16):1647\u20131654."},{"issue":"22","key":"b6","series-title":"J Clin Oncol","first-page":"3072","article-title":"Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group","volume":"29","author":"Fourney DR","year":"2011","unstructured":"Fourney DR, Frangou EM, Ryken TC,  Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 2011;29(22):3072\u20133077."},{"issue":"3","key":"b7","series-title":"J Clin Oncol","first-page":"268","article-title":"Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study","volume":"34","author":"Fehlings MG","year":"2016","unstructured":"Fehlings MG, Nater A, Tetreault L,  Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study. J Clin Oncol. 2016;34(3):268\u2013276."},{"issue":"5","key":"b8","series-title":"J Neurosurg Spine","first-page":"550","article-title":"Surgical management of metastatic disease of the lumbar spine: experience with 139 patients","volume":"2","author":"Holman PJ","year":"2005","unstructured":"Holman PJ, Suki D, McCutcheon I, Wolinsky JP, Rhines LD, Gokaslan ZL. Surgical management of metastatic disease of the lumbar spine: experience with 139 patients. J Neurosurg Spine. 2005;2(5):550\u2013563."},{"issue":"2","key":"b9","series-title":"J Spine Surg","first-page":"372","article-title":"Endoscopic surgical treatment for symptomatic spinal metastases in long-term cancer survivors","volume":"6","author":"Telfeian AE","year":"2020","unstructured":"Telfeian AE, Oyelese A, Fridley J, Doberstein C, Gokaslan ZL. Endoscopic surgical treatment for symptomatic spinal metastases in long-term cancer survivors. J Spine Surg. 2020;6(2):372\u2013382."},{"issue":"11","key":"b10","series-title":"J Am Acad Orthop Surg Glob Res Rev","first-page":"e22.00201","article-title":"Posterior endoscopic cervical decompression in metastatic cervical spine tumors: an alternative to palliative surgery","volume":"6","author":"Kotheeranurak V","year":"2022","unstructured":"Kotheeranurak V, Jitpakdee K, Pornmeechai Y,  Posterior endoscopic cervical decompression in metastatic cervical spine tumors: an alternative to palliative surgery. J Am Acad Orthop Surg Glob Res Rev. 2022;6(11):e22.00201."},{"issue":"5","key":"b11","series-title":"Neurosurgery","first-page":"1148","article-title":"Patient-reported and clinical outcomes of surgically treated patients with symptomatic spinal metastases: results from Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO), a prospective, multi-institutional and international study","volume":"95","author":"Barzilai O","year":"2024","unstructured":"Barzilai O, Sahgal A, Rhines LD,  Patient-reported and clinical outcomes of surgically treated patients with symptomatic spinal metastases: results from Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO), a prospective, multi-institutional and international study. Neurosurgery. 2024;95(5):1148\u20131157."},{"issue":"2","key":"b12","series-title":"Neurosurgery","first-page":"303","article-title":"Metastatic spine disease: should patients with short life expectancy be denied surgical care? 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