Ito Hiroki, Takegami Yasuhiko, Nakashima Hiroaki, Mishima Kenichi, Yamauchi Kenichi, Imagama Shiro
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, JPN.
Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, JPN.
Cureus. 2025 Mar 20;17(3):e80886. doi: 10.7759/cureus.80886. eCollection 2025 Mar.
Purpose Spinal metastases are common and affect most patients with metastatic cancer. Surgery is crucial for managing symptoms such as pain and paralysis but carries a high risk of complications, especially in the elderly. This study aimed to investigate the impact of short versus long fixation on outcomes mainly focused on surgery-related complications in elderly patients ≥60 years old undergoing surgery for single-level spinal metastasis. Methods This study is a retrospective multicenter cohort study. We retrospectively analyzed data from 153 patients who underwent spinal metastasis surgery between 2014 and 2023, focusing on 44 patients aged ≥60 years with single-level lesions. Out of 151 patients, those under 60 years old, those who underwent only decompression surgery, and those with missing data were excluded, resulting in a final inclusion of 44 patients. Patients were divided into short fusion (four or fewer vertebrae) and long fusion (five or more vertebrae) groups. This study aims to compare the impact of short (four or fewer vertebrae) versus long (five or more vertebrae) spinal fixation on surgical and patient-centered outcomes in elderly patients undergoing surgery for single-level spinal metastasis. Patients' demographics, surgical details, and complications were compared between the groups. Results The study included 44 patients: long fusion group (n = 24) and short fusion group (n = 20). No significant between-group differences were found in demographics or surgery-related factors. Minimally invasive surgery was performed in 29.2% of long fusion group patients and 10% of short fusion group patients, but this difference was not statistically significant. Survival analysis showed no significant difference in median survival between the groups (short fusion group = 29 months vs. long fusion group = 26 months, P = 0.533). Mortality rates were also similar between groups during the follow-up period. The short fusion group had a higher rate of surgical complications (45% vs. 12.5%, P = 0.021) and more frequent postoperative complications (55% vs. 29.2%, P=0.125), although the difference was not statistically significant. Conclusion This study found no significant difference in survival rates between short and long fixation in elderly patients undergoing surgery for single-level spinal metastasis. In spinal metastasis surgery, extending the fixation range may be considered if necessary.
目的 脊柱转移瘤很常见，影响大多数转移性癌症患者。手术对于控制疼痛和瘫痪等症状至关重要，但并发症风险很高，尤其是在老年患者中。本研究旨在调查短节段固定与长节段固定对结果的影响，主要关注60岁及以上接受单节段脊柱转移瘤手术的老年患者的手术相关并发症。方法 本研究是一项回顾性多中心队列研究。我们回顾性分析了2014年至2023年间接受脊柱转移瘤手术的153例患者的数据，重点关注44例年龄≥60岁的单节段病变患者。在151例患者中，排除了60岁以下的患者、仅接受减压手术的患者以及数据缺失的患者，最终纳入44例患者。患者分为短节段融合（四个或更少椎体）和长节段融合（五个或更多椎体）组。本研究旨在比较短节段（四个或更少椎体）与长节段（五个或更多椎体）脊柱固定对接受单节段脊柱转移瘤手术的老年患者的手术和以患者为中心的结果的影响。比较两组患者的人口统计学、手术细节和并发症情况。结果 本研究纳入44例患者：长节段融合组（n = 24）和短节段融合组（n = 20）。在人口统计学或手术相关因素方面，两组之间未发现显著差异。长节段融合组29.2%的患者和短节段融合组10%的患者接受了微创手术，但这种差异无统计学意义。生存分析显示两组之间的中位生存期无显著差异（短节段融合组 = 29个月，长节段融合组 = 26个月，P = 0.533）。随访期间两组的死亡率也相似。短节段融合组的手术并发症发生率较高（45%对12.5%，P = 0.021），术后并发症更频繁（55%对29.2%，P = 0.125），尽管差异无统计学意义。结论 本研究发现，接受单节段脊柱转移瘤手术的老年患者中，短节段固定和长节段固定的生存率无显著差异。在脊柱转移瘤手术中，如有必要可考虑扩大固定范围。
