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Management of Metastatic Bone Disease · Journal article
Journal of Personalized Medicine · August 18, 2026
Early or partial results. Treat as a signal, not a conclusion.
This single-center retrospective cohort of 30 patients undergoing total en bloc spondylectomy reports a 5-year overall survival of approximately 76% and identifies extraspinal metastases as an exploratory prognostic signal (HR 3.46, 95% CI 1.23–9.78; p=0.019). The study provides descriptive signals of treatment burden and disease biology associations rather than validated selection criteria, and the findings are hypothesis-generating for future prospective work.
Retrospective single-center cohort study. Adults who underwent total en bloc spondylectomy for spinal tumors; 30 patients analyzed (13 men, 17 women, mean age 54.8 ± 15.2 years). Six screened patients were excluded due to unreliable or missing survival and last-contact data.. Intervention: Total en bloc spondylectomy (TES) for spinal tumors. n = 30. Single center (location not specified in provided text).
Five-year overall survival approximately 76% in the full cohort (18 deaths, 12 alive among 30 patients analyzed) Extraspinal metastases present in 72.2% of deceased patients versus 8.3% of survivors (HR 3.46, 95% CI 1.23–9.78; p=0.019) Metastatic disease demonstrated inferior survival compared with primary bone or soft-tissue tumors
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This exploratory analysis suggests that systemic disease burden, particularly the presence of extraspinal metastases, may inform patient selection for total en bloc spondylectomy in modern practice. However, the findings are preliminary and single-center; prospective validation is needed before using imaging-defined metastatic disease as a selection criterion in routine clinical decision-making.
Single-center retrospective cohort of 30 patients with exploratory survival analysis and no validated selection algorithm; identifies associations rather than establishing causal effects or practice-changing thresholds.
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This exploratory analysis suggests that systemic disease burden, particularly the presence of extraspinal metastases, may inform patient selection for total en bloc spondylectomy in modern practice. However, the findings are preliminary and single-center; prospective validation is needed before using imaging-defined metastatic disease as a selection criterion in routine clinical decision-making.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background/Objectives: Total en bloc spondylectomy (TES) remains one of the most invasive and selectively used procedures in spine oncology. Its role has become more selective in the modern era of stereotactic body radiotherapy, separation surgery, targeted systemic therapy, immunotherapy, and multidisciplinary cancer care. This study evaluated long-term survival, imaging-defined systemic disease burden, operative morbidity, patient-reported outcomes, and frailty-related variables after TES in a rare single-center cohort, with the goal of identifying selection-relevant survival and treatment-burden signals rather than developing a validated decision algorithm. Methods: We performed a retrospective single-center cohort study of consecutive adults who underwent TES for spinal tumors between 2011 and 2022. Of the 36 screened patients, 30 had sufficient clinical and survival data for analysis; patients without reliable survival or last-contact data were not included. Contrast-enhanced CT and PET-CT were reviewed for extraspinal metastases, lymphadenopathy, pleural effusion, and soft-tissue extension. Survival was analyzed using Kaplan–Meier methods, log-rank testing, and exploratory univariate Cox regression. Patient-reported outcomes included the Oswestry Disability Index (ODI) and SF-36 when available; frailty was summarized with the modified frailty index-5 (mFI-5) when component data were present. Results: The cohort included 13 men and 17 women with a mean age of 54.8 ± 15.2 years. At final follow-up, 18 patients had died, and 12 were alive. Five-year overall survival was approximately 76% in the full cohort. Extraspinal metastases were present in 72.2% of deceased patients compared with 8.3% of survivors and showed the clearest exploratory association with increased mortality (HR 3.46, 95% CI 1.23–9.78; p = 0.019). Metastatic disease demonstrated inferior survival compared with primary bone or soft-tissue tumors. Perioperative blood loss and transfusion burden were substantial but were not associated with survival in univariate analysis. ODI and SF-36 data were available only in small subsets and were therefore interpreted as descriptive signals of treatment burden. Conclusions: TES remains relevant in modern spine oncology, but only as an increasingly selective intervention. In this rare cohort, systemic disease burden, particularly extraspinal metastases, was the clearest selection-relevant survival signal, while blood loss, transfusion requirements, complications, and limited patient-reported outcomes illustrated substantial treatment burden. These findings do not establish a validated selection algorithm but support a contemporary decision threshold that integrates tumor biology, systemic disease status, anticipated margins, physiologic reserve, operative morbidity, and patient goals.
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