Efficacy Analysis of Separation Surgery Combined with SBRT for Spinal Metastases-A Long-Term Follow-Up Study Based on Patients with Spinal Metastatic Tumor in a Single-Center

Objective Follow-up data of patients with spinal metastatic tumors were analyzed to investigate the effect of separation surgery combined with SBRT on clinical outcomes. Methods The clinical data of 52 patients with spinal metastatic tumors admitted to our hospital from January 2015 to December 2018 were retrospectively analyzed. There were 24 males and 28 females, aged 25-77 years, with an average of 56.7 +/- 7.4 years. The separation surgery of all patients was successfully completed and followed up. Frankel neurological function grading, Karnofsky performance scores, VAS scores, Epidural spinal cord compression (ESCC) grading and muscle strength grading were used to assess the patients' condition. Kaplan-Meier analysis and the Log-rank test were used to calculate the hazard ratio (HR) and the 95% feasible interval for patients with different ages, genders, and treatments. The multivariate Cox regression model was used to calculate the risk value HR and the 95% feasible interval in patients undergoing only separation surgery or separation surgery combined with SBRT. Results After separation surgery, 46 patients had pain relief (88.5%), and the average VAS score decreased to 2.17 +/- 0.52 points, which was significantly improved compared with preoperative score (P < 0.01). Muscle strength grading decreased in seven cases, showed no change in two cases, and recovered in 19 cases. Postoperative Frankel neurological function grading and Karnofsky performance scores were also significantly improved compared with preoperative scores (P < 0.01). The patients who accepted separation surgery were followed up for 9-47 months (26.3 +/- 18.1 months), and 15 patients died due to the deterioration of the primary tumor. Thirteen patients received SBRT after surgery, including 12 cases of pain relief. The average VAS score of these 13 patients decreased to 1.64 +/- 0.41 points, which was significantly improved compared with preoperative and postoperative (P < 0.01), and muscle strength recovered in eight cases. Frankel neurological function grading and Karnofsky performance scores of these patients were also significantly improved compared with preoperative and postoperative Frankel neurological function grading and Karnofsky performance scores (P < 0.01). The patients who accepted separation surgery combined with SBRT were followed up for 11-38 months (mean 22.5 +/- 10.2 months), and five cases died of primary tumor. Univariate and multivariate analysis showed that separation surgery combined with SBRT was an independent predictor of overall survival rate (OS). Conclusions Separation surgery combined with SBRT is an effective way to treat spinal metastatic tumors as it not only has smaller surgical trauma, but can also significantly relieve pain, improve nerve function, and relieve spinal cord compression.