Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study

Abstract

Objectives To evaluate survival after surgery and indications for surgery due to spinal metastatic disease. Design A retrospective longitudinal multiregistry nationwide cohort study. Setting 19 public hospitals in Sweden with spine surgery service, where 6 university hospitals account for over 90% of the cases. Participants 1820 patients 18 years or older undergoing surgery due to spinal metastatic disease 2006-2018 and registered in Swespine, the Swedish national spine surgery registry. Interventions Decompressive and/or stabilising spine surgery due to spinal metastatic disease. Primary outcome Survival (median and mean) after surgery. Secondary outcomes Indications for surgery, types of surgery and causes of death. Results The median estimated survival after surgery was 6.2 months (95% CI: 5.6 to 6.8) and the mean estimated survival time was 12.2 months (95% CI: 11.4 to 13.1). Neurologic deficit was the most common indication for surgery and posterior stabilisation was performed in 70.5% of the cases. A neoplasm was stated as the main cause of death for 97% of the patients. Conclusion Both median and mean survival times were well above the generally accepted thresholds for surgical treatment for spinal metastases, suggesting that patient selection for surgical treatment on a national level is adequate. Further research on quality of life after surgery and prognostication is needed.