The impact of prior radiation or chemotherapy on surgical outcomes in the treatment of spine metastases.

Study Design: This was a retrospective cohort study. Objective: The objective of this study was to evaluate the impact of prior chemotherapy and/or radiation on outcomes among patients undergoing surgery for spinal metastases. Summary of Background Data: Spinal metastases are associated with significant pain, functional decline, and poor prognosis. Prior chemotherapy and radiation are common and impose a substantial morbidity, but their influence on surgical outcomes remains poorly defined. Materials and Methods: A retrospective chart review of adult patients who underwent surgery for spine metastasis was conducted at a single institution (2017-2022). Demographic, surgical, and oncologic data were collected via manual chart review. Patients were stratified based on a history of chemotherapy and/or radiation. Outcomes included estimated blood loss, length of stay (LOS), rate and number of inpatient complications, 30-day emergency department visits, 90-day readmissions, 1-year reoperation, and 1- and 5-year mortality. Results: Forty-four patients were included (23 received prior chemotherapy/radiation). The most common surgical indication was multiple myeloma in patients with prior therapy (17.39%) and lung metastases in patients without prior therapy (28.57%). Seventeen patients (80.95%) without prior therapy received chemotherapy/radiation postoperatively. Patients with prior therapy experienced shorter LOS (9.78 ± 7.40 vs. 20.0 ± 16.0 days; Conclusions: Prior therapy was associated with reduced LOS and inpatient morbidity. These findings may reflect differences in tumor biology or oncologic patient heterogeneity. Primary tumor types were poorly isolated, and the sample size limited definitive conclusions, further underscoring the need for robust future investigation.