Evidence map›Paper›PMID 39801116›Full record

ArticleGlobal spine journal2025

What is the Optimal Management of Metastatic Spine Patients With Intermediate Spinal Instability Neoplastic Scores: To Operate or Not to Operate?

William Chu Kwan, Scott L Zuckerman, Charles G Fisher, Ilya Laufer, Dean Chou, John E O'Toole, Markus Schultheiss, Michael H Weber, Daniel M Sciubba, Markian Pahuta and 14 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Global spine journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Regional variability and economic impact on surgical practices for metastatic spinal disease in Europe - a survey on spine surgeons.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

William Chu KwanCombined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, BC, Canada.ORCID 0000-0001-6803-0669
Scott L ZuckermanDepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Charles G FisherCombined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, BC, Canada.
Ilya LauferDepartment of Neurological Surgery, New York University Grossman School of Medicine, New York, NY, USA.
Dean ChouThe Neurological Institute of New York, Columbia University Irving Medical Center, New York, NY, USA.
John E O'TooleDepartment of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
Markus SchultheissUniversity of Ulm, Ulm, Germany.
Michael H WeberSpine Surgery Program, Department of Surgery, Montreal General Hospital, Faculty of Medicine, McGill University, Montreal, QC, Canada.
Daniel M SciubbaDepartment of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, New York, NY, USA.
Markian PahutaDepartment of Surgery, McMaster University, Hamilton, ON, Canada.
John H ShinDepartment of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Michael G FehlingsDepartment of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, University Health Network, Toronto, ON, Canada.ORCID 0000-0002-5722-6364
Anne VersteegOrthopaedic Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada.ORCID 0000-0003-3251-9694
Matthew L GoodwinDepartment of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO, USA.
Stefano BorianiSpine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Chetan BettegowdaDepartment of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Aron LazaryNational Center for Spinal Disorders, Budapest, Hungary.ORCID 0000-0002-0157-719X
Alessandro GasbarriniSpine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Jeremy J ReynoldsOxford Spinal Surgery Unit, Oxford University Hospitals, Oxford, UK.
Jorrit-Jan VerlaanDepartment of Orthopaedic Surgery, University Medical Center, Utrecht, The Netherlands.
Arjun SahgalDepartment of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Ziya L GokaslanDepartment of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Laurence D RhinesDepartment of Neurosurgery, Division of Surgery, University of Texas, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Nicolas DeaCombined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, BC, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

designSystematic review.

objectiveIn patients with extradural metastatic spine disease, we sought to systematically review the outcomes and complications of patients with intermediate Spinal Instability Neoplastic Score (SINS) lesions undergoing radiation therapy, percutaneous interventions, minimally invasive surgeries, or open spinal surgeries.

methodsFollowing PRISMA guidelines for systematic reviews, MEDLINE, EMBASE, Web of Science, the Cochrane Database of Systematic Reviews and the Cochrane Center Register of Controlled Trials were queried for studies that reported on SINS intermediate patients who underwent: 1) radiotherapy, 2) percutaneous intervention, 3) minimally invasive, or 4) open surgery. Dates of publication were between 2013-22. Patients with low- or high-grade SINS were excluded. Outcome measures were pain score, functional status, neurological outcome, ambulation, survival, and perioperative complications.

resultsThirty-nine studies (n = 4554) were included that analyzed outcomes in the SINS intermediate cohort. Radiotherapy appeared to provide temporary improvement in pain score; however, recurrent pain led to surgery in 15%-20% of patients. Percutaneous vertebral augmentation provided improvement in pain. Minimally invasive surgery and open surgery offered improvement in pain, quality of life, neurological, and ambulatory outcomes. Open surgery may be associated with more complications. There was limited evidence for radiofrequency ablation.

conclusionIn the SINS intermediate group, radiotherapy was associated with temporary improvement of pain but may require subsequent surgery. Both minimally invasive surgery and open spinal surgery achieved improvements in pain, quality of life, and neurological outcomes for patients with spine metastases. Open surgery may be associated with more complications.

Indexed as

mechanical stabilitymetastasesoncologySINSsurgerytumor

Identifiers

PMID39801116
PMCPMC11988250

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.