In a new study published in European Spine Journal, Ahmad M. Tarawneh, Nottingham University Hospital, Nottingham, England, creates a systematic review aimed at analysing the incidence of complications and unplanned reoperations after surgery for metastatic spinal tumours.
Patients with spinal metastases frequently present with complex therapeutic challenges requiring multi-disciplinary team assessment. Surgical site infection was reported as the main complication following surgery for spinal metastases and the main reason for a re-operation in patients undergoing surgery for spinal metastases.
The spinal column is the most common osseous site for metastatic spread. The goals of the treatment of spinal metastases are largely palliative. The surgical aims include establishing a diagnosis, providing stability, relieving neurological compression and deterioration, decreasing pain and increasing patient independence.
The entitled, Surgical Complications and Re-operation Rates in Spinal Metastases Surgery: A Systematic Review, identified eligible articles up to 2020. Inclusion criteria was for studies reporting the complications and/or unplanned re-operation rates in spinal metastases surgery. Studies were excluded if there was no reported complications or unplanned re-operation rates, or involved lower than 30 cases per study, and repetitive studies. 19 published studies met the inclusion criteria and were included in the review with a total of 4751 patients.
Despite improvements in the oncological control in spinal metastases, a certain proportion of patients undergoing surgical intervention of their spinal metastatic disease experience complications. The included surgical complications were wound complications (surgical site infection), instrumentation failure, and neurological deficit. Wound complications, in terms of surgical site infection, was reported in 6.5% of spinal metastases surgeries. Instrumentation failure was detected in 2.0% of patients. Finally, the overall incidence of neurological deterioration after surgery for spinal metastases was found to be 3.3%.
This study found that the re-operation rate after surgery for spinal metastases to be 8.3%. Surgical site infection was the most common reason 27.8%, followed by instrumentation failure and tumour recurrence with 22.2% for each one of them.
Tarawneh acknowledged several points in relation to the findings, “the study included spinal metastases patients who underwent surgical intervention irrespective of their performance status, previous history of radiation and level of spinal metastases in the spinal column”.
Tarawneh notes that a limitation in the study is the level of evidence for the available literature, commenting that, “future studies with consideration of the aforementioned remarks are warranted.”