{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T14:12:17Z","timestamp":1771078337947,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Eulji University","award":["2024-EMBRI DJ0002"],"award-info":[{"award-number":["2024-EMBRI DJ0002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Radiotherapy is one of the various treatment options for patients with metastatic spinal tumors (MST). However, it is difficult to say that this is definitely an optimal treatment for MST, and there are several patients who need surgical treatment because pain or neurologic deficits occur even after radiotherapy. Therefore, this study aimed to analyze which patients received early operative treatment after radiotherapy. Methods: We included 81 patients who underwent decompression and fusion surgery after radiotherapy for MST. Patients who underwent surgery within 6 months after radiotherapy were classified as the early operation group (group E, n = 47), while surgery cases after 6 months after radiotherapy were assigned to the late operation group (group L, n = 34). Risk factor analysis using multivariate regression analysis for early operative treatment after radiotherapy was performed. Also, we analyzed the period from radiotherapy to surgery according to the Bilsky grade. Results: In multivariate analysis, pathologic fractures and semirigid (thoracic) lesions were more frequent in group E than group L (adjusted odds ratio, 4.282, 10.524; p = 0.001, 0.039). In subgroup analysis, there was a difference in the period from radiotherapy to surgery in Bilsky grades above 2 than Bilsky grade 1 (grade 1, 13.6 \u00b1 11.4 months, grade 2, 6.9 \u00b1 6.8 months, grade 3, 6.6 \u00b1 7.5 months; grade 1 vs. 2, p = 0.049, grade 1 vs. 3, p = 0.047). Conclusions: Although the information in this study may only be limited to patients who underwent surgery, early operative treatment after radiotherapy is highly likely for patients with MST accompanied by a Bilsky grade above 2, pathologic fracture and thoracic lesion. In these patients, surgical treatment could be considered as the primary treatment.<\/jats:p>","DOI":"10.3390\/jcm14031032","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T09:54:38Z","timestamp":1738835678000},"page":"1032","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of Early Post-Radiation Surgical Management of Metastatic Spinal Tumors"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-9836","authenticated-orcid":false,"given":"Sang","family":"Seok","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon 35233, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1178-9778","authenticated-orcid":false,"given":"Jae","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3125-1470","authenticated-orcid":false,"given":"Hyung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Gangneung Asan Hospital, Gangneung 25440, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Asan Medical Center, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong-Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sehan","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"799","DOI":"10.31616\/asj.2022.0367","article-title":"An Updated Review on the Treatment Strategy for Spinal Metastasis from the Spine Surgeon\u2019s Perspective","volume":"16","author":"Hong","year":"2022","journal-title":"Asian Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"390","DOI":"10.31616\/asj.2023.0376","article-title":"Prognostic Factors after Surgical Treatment for Spinal Metastases","volume":"18","author":"Murotani","year":"2024","journal-title":"Asian Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1177\/107327481201900206","article-title":"Surgical management of metastatic spinal tumors","volume":"19","author":"Laufer","year":"2012","journal-title":"Cancer Control"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"324","DOI":"10.31616\/asj.2023.0314","article-title":"Development and internal validation of machine-learning models for predicting survival in patients who underwent surgery for spinal metastases","volume":"18","author":"Santipas","year":"2024","journal-title":"Asian Spine J."},{"key":"ref_5","first-page":"93","article-title":"Nationwide epidemiology and healthcare utilization of spine tumor patients in the adult Korean population, 2009\u20132012","volume":"2","author":"Sohn","year":"2015","journal-title":"Neurooncol Pract"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1093\/neuros\/nyx567","article-title":"State of the art treatment of spinal metastatic disease","volume":"82","author":"Barzilai","year":"2018","journal-title":"Neurosurgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1038\/nrclinonc.2010.137","article-title":"The role of radiotherapy for metastatic epidural spinal cord compression","volume":"7","author":"Rades","year":"2010","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.ijrobp.2015.07.007","article-title":"Technology for Innovation in Radiation Oncology","volume":"93","author":"Chetty","year":"2015","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.5301\/tj.5000215","article-title":"Radiosurgical options in neuro-oncology: A review on current tenets and future opportunities. Part II: Adjuvant radiobiological tools","volume":"101","author":"Ganau","year":"2015","journal-title":"Tumori"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Cho, C.H., Hills, J.M., Anderson, P.A., Annaswamy, T.M., Cassidy, R.C., Craig, C.M., DeMicco, R.C., Easa, J.E., Kreiner, D.S., and Mazanec, D.J. Appropriate Use Criteria for Neoplastic Compression Fractures. Spine J., 2025. in press.","DOI":"10.1016\/j.spinee.2025.02.007"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1016\/j.ijrobp.2006.06.021","article-title":"Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression","volume":"66","author":"Thomas","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.wneu.2014.12.039","article-title":"Comparison of the Therapeutic Efficacy of Surgery with or without Adjuvant Radiotherapy versus Radiotherapy Alone for Metastatic Spinal Cord Compression: A Meta-Analysis","volume":"83","author":"Chen","year":"2015","journal-title":"World Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1093\/neuros\/nyaa380","article-title":"Survival Trends After Surgery for Spinal Metastatic Tumors: 20-Year Cancer Center Experience","volume":"88","author":"Rothrock","year":"2021","journal-title":"Neurosurgery"},{"key":"ref_14","first-page":"4335","article-title":"Prevalence and survival patterns of patients with bone metastasis from common cancers in Thailand","volume":"17","author":"Phanphaisarn","year":"2016","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_15","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_16","doi-asserted-by":"crossref","first-page":"S231","DOI":"10.1097\/BRS.0000000000001822","article-title":"The Spinal Instability Neoplastic Score: Impact on Oncologic Decision-Making","volume":"15","author":"Versteeg","year":"2016","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1200\/JCO.1984.2.3.187","article-title":"Karnofsky performance status revisited: Reliability, validity and guidelines","volume":"2","author":"Schag","year":"1984","journal-title":"J. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Taniwaki, H., Dohzono, S., Sasaoka, R., Takamatsu, K., Hoshino, M., and Nakamura, H. Computed tomography Hounsfield unit values as a treatment response indicator for spinal metastatic lesions in patients with non-small-cell lung cancer: A retrospective study in Japan. Asian Spine J., 2025.","DOI":"10.21203\/rs.3.rs-3977777\/v1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s12957-024-03494-3","article-title":"Efficacy and safety of en-bloc resection versus debulking for spinal tumor: A systematic review and meta-analysis","volume":"22","author":"Zhang","year":"2024","journal-title":"World J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e389","DOI":"10.1016\/j.wneu.2017.09.189","article-title":"Surgery and Radiotherapy for Symptomatic Spinal Metastases Is More Cost Effective Than Radiotherapy Alone: A Cost Utility Analysis in a U.K Spine Center","volume":"109","author":"Turner","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"239","DOI":"10.3171\/2016.1.SPINE151166","article-title":"The use of spine stereotactic radiosurgery for oligometastatic disease","volume":"25","author":"Ho","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e310","DOI":"10.1016\/S1470-2045(13)70101-3","article-title":"Vertebral compression fracture after stereotactic body radiotherapy for spinal metastases","volume":"14","author":"Sahgal","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3426","DOI":"10.1200\/JCO.2013.50.1411","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","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.ijrobp.2016.09.007","article-title":"Analysis of the factors contributing to vertebral compression fractures after spine stretotactic radiosurgery","volume":"97","author":"Elibe","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/BRS.0000000000003227","article-title":"Understanding Thoracic Morphology, Shape, and Proportionality","volume":"45","author":"Lafage","year":"2020","journal-title":"Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"581","DOI":"10.5435\/JAAOS-D-14-00219","article-title":"Spinal cord blood supply and its surgical implications","volume":"23","author":"Colman","year":"2015","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1302\/0301-620X.56B2.225","article-title":"The blood supply of the spinal cord. A critical vascular zone in spinal surgery","volume":"56","author":"Dommisse","year":"1974","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1590\/S0004-282X2007000500033","article-title":"Metastatic tumor of thoracic and lumbar spine: Prospective study comparing the surgery and radiotherapy vs external immobilization with radiotherapy","volume":"65","author":"Falavigna","year":"2007","journal-title":"Arq. Neurosiquiatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/2022.9.FOCUS22403","article-title":"Factors affecting the prognosis of recovery of motor power and ambulatory function after surgery for metastatic epidural spinal cord compression","volume":"53","author":"Park","year":"2022","journal-title":"Neurosurg. Focus."},{"key":"ref_30","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_31","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":"Brande","year":"2022","journal-title":"J. Bone Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0140-6736(05)66954-1","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomized trial","volume":"366","author":"Patchell","year":"2005","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jocn.2018.06.041","article-title":"Factors influencing extended hospital stay in patients undergoing metastatic spine tumour surgery and its impact on survival","volume":"56","author":"Kumar","year":"2018","journal-title":"J. Clin. Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.wneu.2016.08.029","article-title":"Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Leng of Stay After Spine Surgery","volume":"95","author":"Ramos","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1227\/neu.0000000000002586","article-title":"Does Low-Grade Versus High-Grade Bilsky Score Influence Local Recurrence and Overall Survival in Metastatic Spinal Tumor Surgery?","volume":"93","author":"Bendfeldt","year":"2023","journal-title":"Neurosurgery"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/1032\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:28:16Z","timestamp":1760027296000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/1032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,6]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14031032"],"URL":"https:\/\/doi.org\/10.3390\/jcm14031032","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,6]]}}}