Experience With Surgical Spine Stabilization in Patients With Impending Spinal Instability Due to Tumors

Background: Although there is a significant incidence of spinal metastases and hematolymphoid tumors, the treatment strategy (decompression or decompression+stabilization surgery) for patients with impending spinal instability (Spinal Instability Neoplastic Score [SINS] values of 7-12) has not been clearly defined.

Objective: To examine the rationale of decompression or decompression+stabilization surgery in patients with impending spinal instability (SINS values of 7-12) due to spinal metastases and hematolymphoid tumors and to assess treatment results within the specified range of SINS values.

Materials and methods: The study included 92 patients with spinal metastases and hematolymphoid tumors who underwent surgery between January 1, 2014 and December 31, 2022 at the National Medical Research Center for Oncology (Rostov-on-Don, Russian Federation). The main inclusion criterion was SINS values of 7-12. All patients underwent palliative surgical treatment: either decompression and stabilization or decompression alone.

Results: Stabilization of the spinal column was performed in 71 (77%) patients; in 21 (23%) patients, the affected segment was not fixed during surgery. Patients who underwent decompression had a higher rate of postoperative complications, with an increase in postoperative instability of the affected segment being the most significant. As for patients who underwent decompression + stabilization we found a moderate positive correlation between the lesion level and the number of fixed segments (r = 0.33, P< .05) and a weak negative correlation between the residual height of the vertebral body and the number of fixed segments (r = −0.26, P< .05).

Conclusions: Stabilization in patients with impending spinal instability (SINS =  7-12) due to tumors is a more justified treatment strategy than decompression alone

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