Comparison of Surgical Outcomes Between Separation Surgery and Piecemeal Spondylectomy for Spinal Metastasis: A Retrospective Analysis

Abstract

Objective: This study aimed to compare the outcomes between piecemeal spondylectomy and separation surgery for patients with spinal metastasis.Summary of Background Data: Piecemeal spondylectomy and separation surgery are two widely-used treatment options for spinal metastasis. However, no studies have compared the surgical outcomes between both treatment modalities.Methods: Patients with spinal metastasis who underwent piecemeal spondylectomy or separation surgery between August 2017 and April 2020 at our spine center were recruited. Demographic, preoperative, perioperative, and follow-up data were collected and analyzed. Kaplan–Meier analysis and the log-rank test were used to analyze overall survival (OS) and progression-free survival (PFS) in patients with spinal metastasis.Results: Overall, 26 patients were treated with piecemeal spondylectomy, and 29 underwent separation surgery with postoperative stereotactic radiosurgery. Both groups showed significant postoperative improvements in neurological status. The piecemeal spondylectomy group had significantly more blood loss (1784.62 ± 833.64 vs. 1165.52 ± 307.38 ml) and required longer operative time (4.76 ± 0.93 vs. 3.73 ± 1.15 h) than the separation surgery group. No significant difference in OS was found between the groups (P = 0.064); however, patients in the separation surgery group experienced less local recurrence than those in the piecemeal spondylectomy group (P = 0.0014). Notably, significant differences were detected in the development of complications between the groups (P = 0.029).Conclusion: Separation surgery led to less blood loss and reduced complications and had shorter operation time than piecemeal spondylectomy. Although no significant differences were found in OS between the groups, separation surgery was associated with better PFS compared with piecemeal spondylectomy. These findings suggest that separation surgery has some advantages over piecemeal spondylectomy for patients with spinal metastatic disease.

Survival and Neurological Outcomes Following Corpectomy for Spinal Metastatic Disease: A Single Institutional Experience

“…Traditionally, complication rates are higher in patients undergoing corpectomy compared to separation surgery, but both surgeries have wide ranges reported in the literature. The complication rate in this study (n=9, 14.2%) was lower than the corpectomy complication rates reported by Gokaslan et [40,41]. No patients had long-term surgical complications nor did any patients die within 30 days of surgery for reasons related to their surgery.…”

Separation surgery followed by stereotactic ablative radiotherapy for metastatic epidural spinal cord compression: A systematic review and meta-analysis for local progression rate

“…Ten studies were retrospective, including a total of 482 patients, and three studies were prospective studies of 179 patients. Eleven studies reported the sex proportion of included patients, and of these, 58 % were male [18] , [19] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] . Six studies were conducted in the United States, five in China, and two in Japan.…”

“…In the scope of our project, it was difficult to conduct subgroup analysis comparing hybrid therapy with other treatments because there were only single studies comparing it directly with other treatments. Among included studies, one study showed direct comparison of LC rate between hybrid therapy and SABR alone [24] , another showed comparison between hybrid therapy and total en bloc spondylectomy [18] , and the other showed comparison between hybrid therapy and piecemeal spondylectomy [31] . Further analysis will become possible if additional studies that directly compare hybrid therapy with the others are published in the future.…”

Separation Surgery in the Treatment of Spinal Metastasis

“…Due to the limitation of focus debridement, the safety of separation surgery is similar or better than that of other surgical treatments. Xu et al 43 reported 55 patients treated with piecemeal spondylectomy or separation surgery. Patients underwent separation surgery had less blood loss (1165.52 ± 307.38 mL vs 1784.62 ± 833.64 mL), less complications (15.38% vs 3.45%), and shorter operation time (3.73 ± 1.15 h vs 4.76 ± 0.93 h) than piecemeal spondylectomy.…”