Comparison of survival, neurological, and radiographic outcomes between corpectomy and instrumented separation surgery for spinal metastatic disease: A single institutional experience.

OBJECTIVES

Spinal metastatic disease incidence has increased due to advances in radiation and chemotherapy that improve survival. Surgical treatment includes separation surgery, for decompression of neural elements from the tumor to allow for post-operative stereotactic radiation versus maximal tumor resection via corpectomy. Data is mixed on whether more invasive corpectomy for tumor resection provides significant benefit over less invasive separation surgery.

METHODS

A retrospective review of 100 consecutive patients was performed, 60 underwent corpectomy and 40 were treated with instrumented separation surgery. Demographics, tumor characteristics, clinical and radiographic data, treatments, and outcomes were analyzed.

RESULTS

Both groups had similar baseline characteristics in terms of age, cancer type, and preoperative function. Postoperatively, both groups had similar functional outcomes while corpectomy was associated with a significant correction (p = 0.02) in kyphosis by 4 ° compared to separation surgery which was neutral (0 °). The median overall survival did not significantly differ between the two groups. Poor neurologic function was associated with shorter survival. Reoperation rate did not statistically differ between the two groups. The separation surgery group had a higher rate of reoperation for tumor progression, but it did not reach significance (p = 0.057).

CONCLUSION

Compared to separation surgery, corpectomy offers similar functional outcomes with improved segmental kyphosis correction, with possible survival benefit. However, this comes at the cost of added surgical complexity, reflected in greater operative time and need for transfusion. In the right candidate, corpectomy may be favored due to improved anterior column reconstruction and reduced oncologic burden.