When (Not) to Operate on Spinal Metastases

A careful look at survival rates should make us think carefully about when not to offer surgery.

Smart Practice: Preoperative palliative care consults are worth considering for many patients.

What’s the Claim?

A case series from a large cancer center found that about one in five patients over the age of 80 undergoing spinal surgery for metastatic disease experienced one or more major postoperative complications (defined as those resulting in more surgery or considered life-threatening), and that lesions undergoing decompression and cervical levels (compared to lower levels of the spine) were associated with an increased risk of death, as was increased intraoperative blood loss.

No surprises so far, right? Here’s what got our attention: Nearly 10% of patients were discharged to hospice or died in the hospital, and among those who were known to have died — loss to follow-up here was not reported by the authors but looks substantial — the median time to death was only 4.5 months. Given loss to follow-up, it’s probably much worse than that.

If these are the results at a large cancer center, it should prompt a re-think of which patients are offered surgery and which ones are offered palliative care.

How’s It Stack Up?