{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:38:33Z","timestamp":1793407113582,"version":"4.5.0"},"reference-count":44,"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>The primary goals in surgical treatment of spinal metastases are neural decompression and spinal stabilization. Understanding a patient\u2019s functional and oncological status plays a key role in patient selection. Careful patient selection and determining the ideal surgical strategy are paramount to achieving successful outcomes in spinal oncology given the high risk for perioperative morbidity. The aim of this study was to examine instrumented fixation for treatment of spinal metastatic disease and compare outcomes of open versus percutaneous fixation to understand factors that might influence short- and long-term survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective study of patients with metastatic spine tumors who underwent instrumented fixation with or without decompression from 2018 to 2023 at a single institution was performed. Demographic and oncological information, and preoperative and postoperative performance and pain scores, as well as history of surgical or radiation treatment, were collected. The cohort was divided into those who underwent open fixation versus those who underwent percutaneous fixation, and surgical data and instability scores were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 273 patients (127 female and 146 male, mean age 63.6 \u00b1 11.9 years) who underwent instrumented fixation for the treatment of spinal metastases were identified. Univariate analysis showed that the Karnofsky Performance Status (KPS) score at the time of surgery, postoperative hospital length of stay (LOS), and total LOS correlated with both 3- and 12-month survival. Multivariate analysis showed that sex, KPS score, previous radiation therapy, and postoperative LOS were associated with 3- and 12-month survival. There was no significant difference between groups in the mean KPS score at the time of surgery (73.6 vs 73.1, p = 0.354), but the percutaneous fixation group had a higher mean KPS score at 1 year (80.5 vs 84, p = 0.038). Preoperative pain scores were higher in the percutaneous group (mean 6.7 vs 7.6, p = 0.035) than the open fixation group, but there was no difference between groups at 1 year (mean 2.4 vs 2.6, p = 0.861).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Preoperative performance status, prior radiation therapy, and postoperative hospital LOS were associated with overall survival following instrumented fixation for spinal metastases. Overall outcomes were equivocal in open versus percutaneous fixation procedures, with a higher KPS score at 1 year in the percutaneous cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.2.focus24925","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T06:39:30Z","timestamp":1746081570000},"page":"E12","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of open and percutaneous instrumented fixation for the treatment of spinal metastases"],"prefix":"10.3171","volume":"58","author":[{"given":"Arkady","family":"Bilenkin","sequence":"first","affiliation":[{"name":"University of South Florida School of Medicine, Tampa;"},{"name":"Neurosurgical Oncology, Department of Neuro-Oncology, Moffitt Cancer Center, Tampa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Barnes","sequence":"additional","affiliation":[{"name":"Neurosurgical Oncology, Department of Neuro-Oncology, Moffitt Cancer Center, Tampa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Brisco","sequence":"additional","affiliation":[{"name":"Neurosurgical Oncology, Department of Neuro-Oncology, Moffitt Cancer Center, Tampa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junmin","family":"Whiting","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Bioinformatics, Moffitt Cancer Center, Tampa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam D.","family":"Tran","sequence":"additional","affiliation":[{"name":"Neurosurgical Oncology, Department of Neuro-Oncology, Moffitt Cancer Center, Tampa; and"},{"name":"Department of Oncologic Sciences, University of South Florida School of Medicine, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Beer-Furlan","sequence":"additional","affiliation":[{"name":"Neurosurgical Oncology, Department of Neuro-Oncology, Moffitt Cancer Center, Tampa; and"},{"name":"Department of Oncologic Sciences, University of South Florida School of Medicine, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Vogelbaum","sequence":"additional","affiliation":[{"name":"Neurosurgical Oncology, Department of Neuro-Oncology, Moffitt Cancer Center, Tampa; and"},{"name":"Department of Oncologic Sciences, University of South Florida School of Medicine, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K. C.","family":"Liu","sequence":"additional","affiliation":[{"name":"Neurosurgical Oncology, Department of Neuro-Oncology, Moffitt Cancer Center, Tampa; and"},{"name":"Department of Oncologic Sciences, University of South Florida School of Medicine, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"365","article-title":"Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients","volume":"15","author":"Perrin RG","year":"2004","unstructured":"Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15(4):365\u2013373."},{"key":"b2","series-title":"J Bone Oncol","first-page":"100446","article-title":"Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: a systematic review","volume":"35","author":"Van den Brande R","year":"2022","unstructured":"Van den Brande R, Cornips EM, Peeters M, Ost P, Billiet C, Van de Kelft E. Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: a systematic review. J Bone Oncol. 2022;35:100446."},{"issue":"1","key":"b3","series-title":"Ann Neurol","first-page":"40","article-title":"Epidural spinal cord compression from metastatic tumor: diagnosis and treatment","volume":"3","author":"Gilbert RW","year":"1978","unstructured":"Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40\u201351."},{"issue":"6","key":"b4","series-title":"J Neurosurg","first-page":"741","article-title":"Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy","volume":"53","author":"Young RF","year":"1980","unstructured":"Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980;53(6):741\u2013748."},{"issue":"17","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"2240","article-title":"Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases","volume":"25","author":"Bilsky MH","year":"2000","unstructured":"Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine (Phila Pa 1976). 2000;25(17):2240\u20132250."},{"issue":"9486","key":"b6","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."},{"issue":"3","key":"b7","series-title":"J Neurosurg Spine","first-page":"287","article-title":"Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. 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J Neurosurg Spine. 2004;1(3):287\u2013298."},{"issue":"3","key":"b8","series-title":"J Neurosurg Spine","first-page":"207","article-title":"Local disease control for spinal metastases following \"separation surgery\" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients","volume":"18","author":"Laufer I","year":"2013","unstructured":"Laufer I, Iorgulescu JB, Chapman T,  Local disease control for spinal metastases following \"separation surgery\" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine. 2013;18(3):207\u2013214."},{"issue":"10","key":"b9","series-title":"Neuro Oncol","first-page":"1413","article-title":"Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy","volume":"15","author":"Al-Omair A","year":"2013","unstructured":"Al-Omair A, Masucci L, Masson-Cote L,  Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol. 2013;15(10):1413\u20131419."},{"issue":"3","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"298","article-title":"Surgical strategy for spinal metastases","volume":"26","author":"Tomita K","year":"2001","unstructured":"Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine (Phila Pa 1976). 2001;26(3):298\u2013306."},{"key":"b11","series-title":"World Neurosurg","first-page":"e889","article-title":"Minimal access surgery for spinal metastases: prospective evaluation of a treatment algorithm using patient-reported outcomes","volume":"120","author":"Barzilai O","year":"2018","unstructured":"Barzilai O, McLaughlin L, Amato MK,  Minimal access surgery for spinal metastases: prospective evaluation of a treatment algorithm using patient-reported outcomes. World Neurosurg. 2018;120:e889\u2013e901."},{"issue":"6","key":"b12","series-title":"Ann Transl Med","first-page":"103","article-title":"Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence","volume":"6","author":"Pennington Z","year":"2018","unstructured":"Pennington Z, Ahmed AK, Molina CA, Ehresman J, Laufer I, Sciubba DM. Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence. Ann Transl Med. 2018;6(6):103."},{"issue":"5","key":"b13","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson ME","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373\u2013383."},{"issue":"2","key":"b14","series-title":"Acta Orthop Scand","first-page":"143","article-title":"Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients","volume":"66","author":"Bauer HC","year":"1995","unstructured":"Bauer HC, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66(2):143\u2013146."},{"issue":"11","key":"b15","series-title":"Eur Spine J","first-page":"1488","article-title":"Predictive value of seven preoperative prognostic scoring systems for spinal metastases","volume":"17","author":"Leithner A","year":"2008","unstructured":"Leithner A, Radl R, Gruber G,  Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J. 2008;17(11):1488\u20131495."},{"issue":"11","key":"b16","series-title":"Spine J","first-page":"2345","article-title":"Modeling 1-year survival after surgery on the metastatic spine","volume":"15","author":"Ghori AK","year":"2015","unstructured":"Ghori AK, Leonard DA, Schoenfeld AJ,  Modeling 1-year survival after surgery on the metastatic spine. Spine J. 2015;15(11):2345\u20132350."},{"issue":"21","key":"b17","series-title":"J Bone Joint Surg Am","first-page":"1767","article-title":"Development of a prognostic survival algorithm for patients with metastatic spine disease","volume":"98","author":"Paulino Pereira NR","year":"2016","unstructured":"Paulino Pereira NR, Janssen SJ, van Dijk E,  Development of a prognostic survival algorithm for patients with metastatic spine disease. J Bone Joint Surg Am. 2016;98(21):1767\u20131776."},{"issue":"6","key":"b18","series-title":"Spine J","first-page":"759","article-title":"Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!","volume":"17","author":"Amelot A","year":"2017","unstructured":"Amelot A, Balabaud L, Choi D,  Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!. Spine J. 2017;17(6):759\u2013767."},{"key":"b19","series-title":"Spine (Phila Pa 1976)","article-title":"Gender and sex differences in health-related quality of life, clinical outcomes and survival after treatment of metastatic spine disease","author":"Goodwin CR","year":"2023","unstructured":"Goodwin CR, Price M, Goodwin AN,  Gender and sex differences in health-related quality of life, clinical outcomes and survival after treatment of metastatic spine disease. Spine (Phila Pa 1976). 2023."},{"issue":"2","key":"b20","series-title":"Neurosurgery","first-page":"402","article-title":"Survival trends after surgery for spinal metastatic tumors: 20-year cancer center experience","volume":"88","author":"Rothrock RJ","year":"2021","unstructured":"Rothrock RJ, Barzilai O, Reiner AS,  Survival trends after surgery for spinal metastatic tumors: 20-year cancer center experience. Neurosurgery. 2021;88(2):402\u2013412."},{"issue":"7","key":"b21","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 N","year":"2015","unstructured":"Moussazadeh N, Rubin DG, McLaughlin L, Lis E, Bilsky MH, Laufer I. Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability. Spine J. 2015;15(7):1609\u20131617."},{"issue":"12","key":"b22","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":"4","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"365","article-title":"Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients","volume":"15","author":"Perrin RG","year":"2004","unstructured":"Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15(4):365\u2013373."},{"key":"b2","series-title":"J Bone Oncol","first-page":"100446","article-title":"Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: a systematic review","volume":"35","author":"Van den Brande R","year":"2022","unstructured":"Van den Brande R, Cornips EM, Peeters M, Ost P, Billiet C, Van de Kelft E. Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: a systematic review. J Bone Oncol. 2022;35:100446."},{"issue":"1","key":"b3","series-title":"Ann Neurol","first-page":"40","article-title":"Epidural spinal cord compression from metastatic tumor: diagnosis and treatment","volume":"3","author":"Gilbert RW","year":"1978","unstructured":"Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol. 1978;3(1):40\u201351."},{"issue":"6","key":"b4","series-title":"J Neurosurg","first-page":"741","article-title":"Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy","volume":"53","author":"Young RF","year":"1980","unstructured":"Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg. 1980;53(6):741\u2013748."},{"issue":"17","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"2240","article-title":"Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases","volume":"25","author":"Bilsky MH","year":"2000","unstructured":"Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine (Phila Pa 1976). 2000;25(17):2240\u20132250."},{"issue":"9486","key":"b6","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."},{"issue":"3","key":"b7","series-title":"J Neurosurg Spine","first-page":"287","article-title":"Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.","volume":"1","author":"Wang JC","year":"2004","unstructured":"Wang JC, Boland P, Mitra N,  Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. . J Neurosurg Spine. 2004;1(3):287\u2013298."},{"issue":"3","key":"b8","series-title":"J Neurosurg Spine","first-page":"207","article-title":"Local disease control for spinal metastases following \"separation surgery\" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients","volume":"18","author":"Laufer I","year":"2013","unstructured":"Laufer I, Iorgulescu JB, Chapman T,  Local disease control for spinal metastases following \"separation surgery\" and adjuvant hypofractionated or high-dose single-fraction stereotactic radiosurgery: outcome analysis in 186 patients. J Neurosurg Spine. 2013;18(3):207\u2013214."},{"issue":"10","key":"b9","series-title":"Neuro Oncol","first-page":"1413","article-title":"Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy","volume":"15","author":"Al-Omair A","year":"2013","unstructured":"Al-Omair A, Masucci L, Masson-Cote L,  Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol. 2013;15(10):1413\u20131419."},{"issue":"3","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"298","article-title":"Surgical strategy for spinal metastases","volume":"26","author":"Tomita K","year":"2001","unstructured":"Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine (Phila Pa 1976). 2001;26(3):298\u2013306."},{"key":"b11","series-title":"World Neurosurg","first-page":"e889","article-title":"Minimal access surgery for spinal metastases: prospective evaluation of a treatment algorithm using patient-reported outcomes","volume":"120","author":"Barzilai O","year":"2018","unstructured":"Barzilai O, McLaughlin L, Amato MK,  Minimal access surgery for spinal metastases: prospective evaluation of a treatment algorithm using patient-reported outcomes. World Neurosurg. 2018;120:e889\u2013e901."},{"issue":"6","key":"b12","series-title":"Ann Transl Med","first-page":"103","article-title":"Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence","volume":"6","author":"Pennington Z","year":"2018","unstructured":"Pennington Z, Ahmed AK, Molina CA, Ehresman J, Laufer I, Sciubba DM. Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence. Ann Transl Med. 2018;6(6):103."},{"issue":"5","key":"b13","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson ME","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373\u2013383."},{"issue":"2","key":"b14","series-title":"Acta Orthop Scand","first-page":"143","article-title":"Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients","volume":"66","author":"Bauer HC","year":"1995","unstructured":"Bauer HC, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66(2):143\u2013146."},{"issue":"11","key":"b15","series-title":"Eur Spine J","first-page":"1488","article-title":"Predictive value of seven preoperative prognostic scoring systems for spinal metastases","volume":"17","author":"Leithner A","year":"2008","unstructured":"Leithner A, Radl R, Gruber G,  Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J. 2008;17(11):1488\u20131495."},{"issue":"11","key":"b16","series-title":"Spine J","first-page":"2345","article-title":"Modeling 1-year survival after surgery on the metastatic spine","volume":"15","author":"Ghori AK","year":"2015","unstructured":"Ghori AK, Leonard DA, Schoenfeld AJ,  Modeling 1-year survival after surgery on the metastatic spine. Spine J. 2015;15(11):2345\u20132350."},{"issue":"21","key":"b17","series-title":"J Bone Joint Surg Am","first-page":"1767","article-title":"Development of a prognostic survival algorithm for patients with metastatic spine disease","volume":"98","author":"Paulino Pereira NR","year":"2016","unstructured":"Paulino Pereira NR, Janssen SJ, van Dijk E,  Development of a prognostic survival algorithm for patients with metastatic spine disease. J Bone Joint Surg Am. 2016;98(21):1767\u20131776."},{"issue":"6","key":"b18","series-title":"Spine J","first-page":"759","article-title":"Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!","volume":"17","author":"Amelot A","year":"2017","unstructured":"Amelot A, Balabaud L, Choi D,  Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!. Spine J. 2017;17(6):759\u2013767."},{"key":"b19","series-title":"Spine (Phila Pa 1976)","article-title":"Gender and sex differences in health-related quality of life, clinical outcomes and survival after treatment of metastatic spine disease","author":"Goodwin CR","year":"2023","unstructured":"Goodwin CR, Price M, Goodwin AN,  Gender and sex differences in health-related quality of life, clinical outcomes and survival after treatment of metastatic spine disease. Spine (Phila Pa 1976). 2023."},{"issue":"2","key":"b20","series-title":"Neurosurgery","first-page":"402","article-title":"Survival trends after surgery for spinal metastatic tumors: 20-year cancer center experience","volume":"88","author":"Rothrock RJ","year":"2021","unstructured":"Rothrock RJ, Barzilai O, Reiner AS,  Survival trends after surgery for spinal metastatic tumors: 20-year cancer center experience. Neurosurgery. 2021;88(2):402\u2013412."},{"issue":"7","key":"b21","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 N","year":"2015","unstructured":"Moussazadeh N, Rubin DG, McLaughlin L, Lis E, Bilsky MH, Laufer I. Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability. Spine J. 2015;15(7):1609\u20131617."},{"issue":"12","key":"b22","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."}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/5\/article-pE12.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/5\/article-pE12.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/58\/5\/article-pE12.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:24:53Z","timestamp":1780734293000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/58\/5\/article-pE12.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":44,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2025.2.focus24925","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}