363 Treatment of Spinal Metastasis in the 21th Century

Abstract

INTRODUCTION: Spinal metastases may present with different degrees of mechanical instability. The Spinal Instability Neoplastic Score (SINS) was developed to assess spinal neoplastic-related instability. Few have validated it clinically METHODS: A retrospective analysis of patients with a pathologic fracture due to a spinal metastasis between 01/2018-12/2020 was performed. We selected patients with a minimum follow-up of 12 months and analyzed them according to the SINS criteria. In the conservative-group group no spinal surgery was perfomed, in contrast the patients in the surgical-group underwent one or more surgeries, respectively. For both groups were the primary endpoint the progression of vertebral-body fracture following radiotherapy. RESULTS: In the conservative-group 332 Patients were identified. 30/283/19 Patients presented with low/moderate/high SINS, respectively. Fracture progression following radiotherapy was seen in 30%/30%/42% in cases with low/moderate/high SINS (P = 0.522), respectively. 17% of the progression cases in the moderate-group developed neurological deficits. In the interventional-group 35 patient were identified. 6/48/16 Patient presented with low/moderate/high SINS, respectively. Fracture-progression following radiotherapy was not seen in any case. In all cases we did not see any secondary alignment disorder or hints for an instability like loosening-hem. The overall survival was 59% in the conservative-group and 75% in the interventional-group. Analyzing the quality of life, we choose the walking-ability as a main-feature. 92% in the interventional-group are still able to walk, in contrast 86% in the conservative-group. CONCLUSIONS: SINS is an especially useful tool for assess stability of a pathologic fractures. Moderate or high SINS are associated with a remarkably high risk of fracture progression as well as risk for neurological deterioration. Furthermore, there are hints, that a corpectomy is not always necessary due to the secondary strengthening of the vertebral body by radio oncology.