Clinical outcomes and performance status improvement after posterior spinal fixation surgery for metastatic spinal tumors: A retrospective case-series study

Context: Posterior spinal fixation surgery can improve performance status (PS), alleviate neurological deficits, and reduce pain in patients with metastatic spinal tumors. However, surgical indications and timing vary based on individual patient conditions. Aims: To evaluate postoperative course and improvement in PS following posterior spinal fixation surgery for metastatic spinal tumors. Settings and Design: Single-center and retrospective case-series study. Subjects and Methods: We included 33 patients who underwent posterior spinal fixation surgery for metastatic spinal tumors from April 2017 to April 2024. PS and modified Frankel classification for paralysis were assessed 2 weeks’ postsurgery. Statistical Analysis Used: Fisher’s exact test and Kaplan–Meier survival curves with a log-rank test were used for the analysis. Results: The cohort included 33 patients (25 men, 8 women; average age, 69 years). Lung cancer was the most common primary tumor ( n = 10). Surgical sites included the cervical ( n = 4), thoracic ( n = 14), thoracolumbar junction ( n = 10), and lumbar/sacral ( n = 5) regions. The median postoperative survival time was 25 months. Preoperative PS was 0–2 in 23 cases and 3–4 in 10 cases. Preoperative modified Frankel classification included A ( n = 3), B ( n = 2), C ( n = 3), D ( n = 9), and E ( n = 16). Significant PS improvement was observed in the PS 0–2 group compared with that in the PS 3–4 group ( P = 0.0209). Paralysis improvement was observed in 3 cases. Conclusions: Spinal fixation can improve PS in patients with preoperative PS of 0–2. Patients with poor initial PS may not experience expected improvements, requiring cautious surgical intervention, and thorough prognostic evaluation.