Medical Student University of Iowa Hospital and Clinic Department of Neurosurgery Iowa City, Iowa, United States
Introduction: Metastatic spinal tumors represent 90% of all spinal masses and can present variably with slow progression or rapid worsening of symptoms. Several prognostic scoring systems have been proposed. However, patients presenting acutely with spinal metastases requiring emergent surgery may represent a unique subset of patients with different prognostic indicators. We sought to identify preoperative factors associated with short-term survival in patients who underwent emergent surgery for acutely symptomatic spinal metastases.
Methods: All cases of symptomatic spinal metastases requiring emergent surgery (≤72 hours following presentation) between 2010-2021 at our institution were retrospectively reviewed. Survival time from date of surgery to death or last follow-up was calculated. Patients were stratified based on whether they survived for more or less than 6 months following surgery. Multivariate Firth Logistic Regression was used to develop a model predicting the probability of mortality at 6 months.
Results: Forty-four patients satisfied inclusion criteria. Mean age at presentation was 60.4 ± 11.8 years with a median survival time of 6.5 [1.9-19.5 IQR] months. For 91% (40/44) of patients, primary malignancy was unknown at presentation. Univariate analysis found that higher Tokuhashi Score, Karnofksy Performance Score (KPS), and lower Modified McCormick Scale were significantly associated with 6-month survival (p=0.018, p< 0.001, p=0.002, respectively). Preoperative ASIA Grade and SINS Score were not associated with survival. Multivariate analysis found KPS significantly correlated with survival (0.91 OR, 0.85-0.98, 95% CI, p=0.011) at 6 months and that a stepwise regression model derived from KPS and Tokuhashi Score demonstrated the highest predictive accuracy for 6-month survival (AUC=0.843, AIC=37.1, p=0.0039).
Conclusion : KPS and Tokuhashi Score most strongly correlated with 6-month survival in patients presenting with acutely symptomatic spinal metastases. These findings underscore the importance of baseline functional status on survival and may be useful for preoperative evaluation and surgical decision-making in the setting of acutely presenting spinal metastases.
