Spinal tumors present diagnostic and surgical challenges due to their anatomical and histological heterogeneity. Reliable determinants of postoperative outcome and revision surgery remain limited across mixed tumor cohorts. Which clinical, tumor-related and surgical factors predict postoperative neurological outcome and the need for revision surgery in patients undergoing spinal tumor resection? Single-center retrospective cohort of 344 resections in 326 patients during a 10-year period. Tumors were classified by anatomical compartment located intradural-extramedullary (45.3%), extradural (29.7%) or intramedullary (25.0%). Clinical outcome was defined as postoperative neurological outcome and revision surgery. Multivariate logistic regression was used to identify determinants of outcome. Neurological improvement or stability was achieved in 84.6% of cases, with the best outcomes in intradural extramedullary tumors (90.3%). Revision surgery was required in 9.0% of cases. Gross total resection (GTR) was achieved in 71% and was the strongest positive determinator of favorable outcome (OR 1.9, p=0.0266), while perioperative complications significantly reduced the likelihood of improvement (OR 0.6, p=0.0230). Malignant histology and subtotal resection were associated with higher revision rates. Intraoperative neuromonitoring (IONM) showed a non-significant trend toward improved outcomes but was used more frequently in high-risk cases. Significant IONM deterioration occurred in 5.3% correlating with poorer long-term outcomes despite not determining immediate postoperative deterioration. Surgical outcome in spinal tumor patients is primarily determined by achieving safe GTR and minimizing perioperative complications. Tumor histology and anatomical location significantly influence prognosis. IONM remains valuable in complex cases. • Tumor histology and anatomical location are strong predictors of surgical outcomes in spinal tumor cases. • Gross total resection is significantly associated with better neurological improvement and lower revision rates. • Perioperative complications are the most significant negative prognostic factor for clinical recovery. • Revision surgeries were more frequent in cases of subtotal resection, metastases, and longer operative time. • IONM signal change strongly predicts worse postoperative outcome, with a highly significant association (χ 2 = 26.89, p = 6.2×10 -6 ) This retrospective study of 344 spinal tumor surgeries identifies histology, tumor location, resection extent, and perioperative complications as key predictors of clinical outcome and revision surgery. The findings support tailored surgical strategies and early risk identification in managing spinal neoplasms.
Winter et al. (Fri,) studied this question.