{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:31:25Z","timestamp":1760149885246,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T00:00:00Z","timestamp":1695772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. Methods: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. Results: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord\/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (&gt;35 d) to radiation therapy as a solitary risk factor (p &lt; 0.001) for occurrence of SCS during follow-up. Conclusion: Surgical treatment of spinal metastatic disease improves patients\u2019 quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.<\/jats:p>","DOI":"10.3390\/cancers15194749","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T07:38:46Z","timestamp":1695800326000},"page":"4749","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Local Recurrence and Development of Spinal Cord Syndrome during Follow-Up after Surgical Treatment of Metastatic Spine Disease"],"prefix":"10.3390","volume":"15","author":[{"given":"Peter","family":"Kn\u00f6ll","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0788-4681","authenticated-orcid":false,"given":"Moritz","family":"Lenschow","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volker","family":"Neuschmelting","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9873-1711","authenticated-orcid":false,"given":"Niklas","family":"von Spreckelsen","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergej","family":"Telentschak","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9733-3589","authenticated-orcid":false,"given":"Sebastian","family":"Olbr\u00fcck","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"},{"name":"Faculty of Medicine, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Rosenbrock","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peer","family":"Eysel","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6203-8616","authenticated-orcid":false,"given":"Sebastian G.","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,27]]},"reference":[{"key":"ref_1","first-page":"309","article-title":"The Incidence of Vertebral Body Metastases","volume":"19","year":"1995","journal-title":"Int. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Walter, S.G., Gaisendrees, C., Kernich, N., Weber, M., Scheyerer, M.J., Eysel, P., Siewe, J., and Zarghooni, K. (2023). Epidemiology of Surgically Treated Spinal Tumors: A Multicenter Surveillance Study of 9686 Patients from the German Spine Registry (DWG Register). Z. Orthop. Unfall., ahead of print.","DOI":"10.1055\/a-2077-7155"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100446","DOI":"10.1016\/j.jbo.2022.100446","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":"Peeters","year":"2022","journal-title":"J. Bone Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kakutani, K., Kanda, Y., Yurube, T., Takeoka, Y., Miyazaki, K., Ohnishi, H., Matsuo, T., Ryu, M., Kuroshima, K., and Kumagai, N. (2023). The Identification of Risk Factors for Symptomatic Spinal Metastasis Onset: A Prospective Cohort Study of 128 Asymptomatic Spinal Metastasis Patients. Cancers, 15.","DOI":"10.3390\/cancers15041251"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Shiber, M., Kimchi, G., Knoller, N., and Harel, R. (2023). The Evolution of Minimally Invasive Spine Tumor Resection and Stabilization: From K-Wires to Navigated One-Step Screws. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020536"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"79S","DOI":"10.1177\/2192568219895265","article-title":"The Role of Minimal Access Surgery in the Treatment of Spinal Metastatic Tumors","volume":"10","author":"Barzilai","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1186\/s13014-020-01715-z","article-title":"Long-Term Outcome after Combined Kyphoplasty and Intraoperative Radiotherapy (Kypho-IORT) for Vertebral Tumors","volume":"15","author":"Bludau","year":"2020","journal-title":"Radiat. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E441","DOI":"10.36076\/ppj\/2019.22.E441","article-title":"Prospective Evaluation Spinal Radiofrequency Ablation Combined with Cement Augmentation for Painful Spinal Vertebral Metastasis: A Single-Center Prospective Study","volume":"22","author":"Sayed","year":"2019","journal-title":"Pain Physician"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1093\/neuros\/nyz472","article-title":"Metastatic Spine Disease: Should Patients with Short Life Expectancy Be Denied Surgical Care? An International Retrospective Cohort Study","volume":"87","author":"Dea","year":"2020","journal-title":"Neurosurgery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1097\/01.BRS.0000048646.26222.FA","article-title":"Quality of Life in Surgical Treatment of Metastatic Spine Disease","volume":"28","author":"Wai","year":"2003","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1007\/s00586-011-1867-6","article-title":"Surgery Improves Pain, Function and Quality of Life in Patients with Spinal Metastases: A Prospective Study on 118 Patients","volume":"20","author":"Quan","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rades, D., K\u00fcchler, J., Graum\u00fcller, L., Abusamha, A., Schild, S.E., and Gliemroth, J. (2022). Radiotherapy with or without Decompressive Surgery for Metastatic Spinal Cord Compression: A Retrospective Matched-Pair Study Including Data from Prospectively Evaluated Patients. Cancers, 14.","DOI":"10.3390\/cancers14051260"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1634\/theoncologist.2012-0293","article-title":"The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors","volume":"18","author":"Laufer","year":"2013","journal-title":"Oncologist"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E1221","DOI":"10.1097\/BRS.0b013e3181e16ae2","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","year":"2010","journal-title":"Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ijrobp.2022.05.043","article-title":"Mature Local Control and Reirradiation Rates Comparing Spine Stereotactic Body Radiation Therapy with Conventional Palliative External Beam Radiation Therapy","volume":"114","author":"Zeng","year":"2022","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1038\/sc.1969.30","article-title":"The Value of Postural Reduction in the Initial Management of Closed Injuries of the Spine with Paraplegia and Tetraplegia","volume":"7","author":"Frankel","year":"1969","journal-title":"Spinal Cord"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"324","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability Analysis of the Epidural Spinal Cord Compression Scale","volume":"13","author":"Bilsky","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/BSD.0000000000001213","article-title":"Quality of Life Changes After Surgery for Metastatic Spinal Disease: A Systematic Review and Meta-Analysis","volume":"35","author":"Groot","year":"2022","journal-title":"Clin. Spine Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/BSD.0000000000000484","article-title":"Perioperative Complications of Spinal Metastases Surgery","volume":"30","author":"Luksanapruksa","year":"2017","journal-title":"Clin. Spine Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.spinee.2018.05.037","article-title":"Complications and Reoperations after Surgery for 647 Patients with Spine Metastatic Disease","volume":"19","author":"Ogink","year":"2019","journal-title":"Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1097\/00007632-200208150-00021","article-title":"Surgery for Solitary Metastases of the Spine: Rationale and Results of Treatment","volume":"27","author":"Sundaresan","year":"2002","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00590-019-02541-0","article-title":"Complications of Spine Surgery for Metastasis","volume":"30","author":"Igoumenou","year":"2019","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"19983","DOI":"10.1038\/s41598-022-23579-x","article-title":"Complications Associated to Wound Drainages in Tumor Spine Surgery: A Multicenter Surveillance Study from the German Spine Registry (DWG-Register)","volume":"12","author":"Walter","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/os.12334","article-title":"Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team","volume":"9","author":"Curtin","year":"2017","journal-title":"Orthop. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"i45","DOI":"10.1093\/nop\/npaa045","article-title":"Management of Recurrent or Progressive Spinal Metastases: Reirradiation Techniques and Surgical Principles","volume":"7","author":"Kotecha","year":"2020","journal-title":"Neuro-Oncol. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1097\/00007632-199909150-00014","article-title":"Complication, Survival Rates, and Risk Factors of Surgery for Metastatic Disease of the Spine","volume":"24","author":"Wise","year":"1999","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/j.ijrobp.2015.03.037","article-title":"Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence","volume":"92","author":"Bishop","year":"2015","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3171\/2012.11.SPINE12111","article-title":"Local Disease Control for Spinal Metastases Following \u201cSeparation Surgery\u201d and Adjuvant Hypofractionated or High-Dose Single-Fraction Stereotactic Radiosurgery: Outcome Analysis in 186 Patients","volume":"18","author":"Laufer","year":"2013","journal-title":"J. Neurosurg. Spine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"15330338221107208","DOI":"10.1177\/15330338221107208","article-title":"Separation Surgery in the Treatment of Spinal Metastasis","volume":"21","author":"Li","year":"2022","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lenschow, M., Lenz, M., von Spreckelsen, N., Ossmann, J., Meyer, J., Ke\u00dfling, J., Nadjiri, L., Telentschak, S., Zarghooni, K., and Kn\u00f6ll, P. (2022). Impact of Spinal Instrumentation on Neurological Outcome in Patients with Intermediate Spinal Instability Neoplastic Score (SINS). Cancers, 14.","DOI":"10.3390\/cancers14092193"},{"key":"ref_31","unstructured":"Hsu, F.-M., Xiao, F., Lin, P.-C., and Chen, Y.-H. (2018). Neoadjuvant Stereotactic Body Radiation Therapy for Spine Metastases Medical Images View Project Neurocognitive Outcome of Conformal WBRT w\/Wo Hippocampal Avoidance for Brain Metastases View Project Neoadjuvant Stereotactic Body Radiation Therapy for Spine Metastases. Artic. J. Spine Neurosurg., 7."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/19\/4749\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:59:32Z","timestamp":1760129972000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/19\/4749"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,27]]},"references-count":31,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["cancers15194749"],"URL":"https:\/\/doi.org\/10.3390\/cancers15194749","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2023,9,27]]}}}