Surgical Extent of Metastatic Spine Tumor Excision and Its Effects on Postoperative Ambulatory Function: Comparison of Extensive Wide versus Palliative Excision Surgery

Study Design: Retrospective study. Objectives: To compare surgical outcomes such as the ambulatory period and survival according to different surgical excision tactics for metastatic spine tumors (MSTs). Summary of Literature Review: Surgical outcomes, such as pain relief and survival, in patients with MSTs have been reported in several studies, but the effects of differences in surgical extent on the ambulatory period have rarely been reported. Materials and Methods: Ninety-six patients with MSTs who underwent palliative (n=60) or extensive wide excision (n=36) were included. Palliative excision was defined as partial removal of the tumor as an intralesional piecemeal procedure for decompression. Extensive wide excision was defined as a surgical attempt to remove the whole tumor at the index level as completely as possible. The primary outcome was the ambulatory period following surgery. Other demographic and radiographic parameters were analyzed to identify the risk factors for loss of ambulatory ability and survival. Perioperative complications were also assessed. Results: The mean postoperative ambulatory period was longer in the extensive wide excision group (average 14.8 months) than in the palliative excision group (average 11.7 months) (p=0.021). The survival rates were not significantly different between the two surgical excision groups (p=0.680). However, postoperative ambulatory status and major complications within 30 days postoperatively were significant prognostic factors for survival (p=0.003 and p=0.032, respectively). Conclusions: The extent of surgical excision affected the ambulatory period, and the complication rates were similar, regardless of surgical excision tactics. A proper surgical strategy to achieve postoperative ambulatory ability and to reduce perioperative complications would have a favorable effect on survival.