Management of metastatic spinal disease in low- and middle-income countries: an international survey of practices and challenges in Latin America
Rattachement africain : mx, es, do, ru, us, ar, lk, it, tr, pk. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Spinal metastases impose urgent diagnostic and therapeutic demands; however, evidence from low- and middle-income countries (LMICs) in Latin America is sparse. We aimed to characterize real-world practices, access gaps, and priorities to in-form context-adapted guidelines. We conducted a multinational, cross-sectional online survey (September-October 2025) of licensed clinicians managing spinal metastases across 20 Latin American countries. A validated multilingual instrument (60 items; Cronbach's α = 0.87) assessed practice patterns, diagnostic and therapeutic resources, perceived complications and outcomes, and barriers to care. Because this was a clinician-reported survey rather than a patient-level registry, estimates of survival, complications, neurological or ambulatory recovery, length of stay, and reintervention were considered perceptions of local practice and were not interpreted as objective clinical outcomes or measures of treatment effectiveness. A total of 1,318 complete responses were analyzed using descriptive and nonparametric comparative statistics. Respondents were predominantly neurosurgeons (63.4%) and orthopedic spine surgeons (34.3%); most practiced in tertiary centers (88.0%) and managed 10-50 spinal metastasis cases annually (76.6%). Diagnostic capacity was uneven: MRI was the preferred initial study (69.9%), yet round-the-clock availability existed in only 40.5%; advanced imaging was routine in 20.9% and unavailable in 30.1%. Symptom-to-diagnosis intervals were 1-3 months in 56.9% and > 6 months in 13.7%, with longer delays in public and lower-middle-income settings (p ≤ 0.041). Biopsy access was present in 90.9%, but pathology turnaround exceeded two weeks in 26.1%. Surgical access was always selected in 86.3%; open surgery predominated (56.9%), combined approaches 29.4%, and minimally invasive surgery 8.5%. Time-to-surgery exceeded two weeks for 26.8% of cases. Stereotactic body radiotherapy was available in 14.4%, and initiation of radiotherapy occurred > 1 month after indication in 62.7%. Economic cost (46.7%), limited instrumentation (19.7%), and delayed diagnosis (19.1%) were leading barriers. Multidisciplinary tumor boards were routine in 35.3%. Reported survival exceeded one year in 59.3% of practices; common complications included infection (33.8%), implant failure (25.0%), and pulmonary events (22.3%). Standardized outcome scales were used routinely by 79.6%. In Latin America, clinicians demonstrate broad expertise but face systemic constraints (diagnostic delays, restricted advanced imaging/navigation, limited SBRT, and high out-of-pocket costs), that blunt timely, integrated care. Priority actions include accelerating diagnostic pipelines, expanding radiotherapy and navigation assisted capacity, strengthening multidisciplinary pathways, and implementing financial protection. Regionally coordinated registries and targeted training are essential to narrow equity gaps in metastatic spine care.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Management of metastatic spinal disease in low- and middle-income countries: an international survey of practices and challenges in Latin America
- Date Crossref
- 19/09/2026
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Instituto Nacional de Cancerología pays non établi dans la noticeOrganisme public
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Institute for Social Security and Services for State Workers pays non établi dans la noticeOrganisme public
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Complejo Hospitalario de Salamanca pays non établi dans la noticeÉtablissement de santé
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Universidad Iberoamericana pays non établi dans la noticeUniversité ou école supérieure
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Peoples' Friendship University of Russia pays non établi dans la noticeUniversité ou école supérieure
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Sechenov University Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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SUNY Downstate Health Sciences University Department of Surgery pays non établi dans la noticeÉtablissement de santé
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Brookdale University Hospital and Medical Center Department of Neurosurgery/Surgery pays non établi dans la noticeÉtablissement de santé
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Hospital Italiano de Buenos Aires Spine Unit pays non établi dans la noticeÉtablissement de santé
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Instituto Tecnológico de Santo Domingo pays non établi dans la noticeUniversité ou école supérieure
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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán pays non établi dans la noticeStructure de recherche
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National Institute of Health Sciences pays non établi dans la noticeOrganisme public
Instituto Nacional de Cancerología, Institute for Social Security and Services for State Workers et Complejo Hospitalario de Salamanca, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.