SADA-08 FUSION SURGERY FOR PATIENTS WITH METASTATIC SPINE DISEASE: IS FUSION NECESSARY?

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Abstract Introduction Metastatic spine disease (MSD) occurs in up to 40% of cancer patients; advancements in treatment including systemic therapies, radiotherapy, and surgical decompression and stabilization have improved outcomes and extended survival. As a result, the long-term integrity of spine instrumentation is of increasing importance. Methods The AO Spine Knowledge Forum Tumor, an international group of spine oncology experts, reviewed a literature search including key words regarding surgical care of MSD patients including: spinal metastases, fusion rate, pseudoarthrosis, radiotherapy, infection, outcome, and wound healing complication. A total of 12 articles met inclusion criteria and four papers were selected as key articles to evaluate this topic. These articles specifically evaluated postoperative radiographic fusion outcomes. Results Several key points arise from the selected papers. The evidence demonstrates multiple studies with low rates of radiographic fusion in the MSD population, likely due to low overall median survival and not enough time to achieve bony fusion. Non-instrumented surgery appears to be safe and effective in some circumstances with one retrospective study of 30 patients undergoing decompression without fusion and no patients necessitating conversion to instrumented surgery. Studies designate the Spine Instability Neoplastic Score (SINS) as a framework for determining which of these patients will require instrumentation and possible fusion, which still remains the case for many patients with significant bony destruction and the need for postoperative radiotherapy. When instrumenting, postoperative radiotherapy planning must be kept in mind. Conclusion The authors conclude that instrumented stabilization without formal fusion is a reasonable and potentially preferable approach for many patients with spinal metastases. This is especially true in cases of limited life expectancy and lower instability scores.

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