Navigating the surgical dilemma in metastatic spine disease: does age influence treatment strategy and outcomes?
Objective - Spinal metastases are increasingly common. Yet, the optimal surgical strategy—particularly in elderly patients—remains debated due to perioperative risks. This study examines demographics, clinical presentation, and surgical outcomes, focusing on age-related differences and management of...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
February 2026
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| In: |
World neurosurgery
Year: 2026, Volume: 206, Pages: 1-9 |
| ISSN: | 1878-8769 |
| DOI: | 10.1016/j.wneu.2025.124720 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.wneu.2025.124720 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S1878875025010782 
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| Author Notes: | Meltem Ivren, Dilber Yalman, Basem Ishak, Sebastian Ille, Sandro M. Krieg, Pavlina Lenga |
| Summary: | Objective - Spinal metastases are increasingly common. Yet, the optimal surgical strategy—particularly in elderly patients—remains debated due to perioperative risks. This study examines demographics, clinical presentation, and surgical outcomes, focusing on age-related differences and management of patients with Spinal Instability Neoplastic Score (SINS) 7-12. - Methods - We retrospectively included all patients with spinal metastases operated in our department from 2015 to 2024. Data on demographics, neurological status, surgical approach, complications and 90-day mortality were collected. - Results - 217 patients (median age: 60 years, range: 5-88) were included. Lung (17%), breast (17%), and prostate (12%) were the most common primaries. Older patients presented with worse neurological deficits (Frankel A/B: 36% vs. 5%, P < 0.01) but had comparable short-term mortality (≥65 years: 15% vs. <65 years: 13%, P = 0.837) and lower intraoperative blood loss (260 ± 373 mL vs. 759 ± 860 mL, P < 0.001). Surgical approaches were similar across age groups, with instrumentation in 32% and minimally invasive techniques in 18%. Regarding SINS, older patients were more frequently categorized as potentially unstable (65% vs. 38%, P < 0.001) yet more frequently treated with decompression. Younger patients undergoing instrumentation predominantly had SINS 7-18. - Conclusions - Age alone does not determine surgical success or survival in metastatic spine disease. Despite worse baseline status, older patients achieved short-term outcomes comparable to younger patients. Variation in managing SINS 7-12 suggests underuse of instrumentation in older patients underscoring the need for age-inclusive evidence-based guidelines integrating SINS with tumor biology, functional status and prognosis. |
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| Item Description: | Gesehen am 15.04.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1878-8769 |
| DOI: | 10.1016/j.wneu.2025.124720 |