• Hesham Mostafa Zakaria, Brandon Michael Wilkinson, Zach Pennington, Yamaan S Saadeh, Darryl Lau, Ankush Chandra, A Karim Ahmed, Mohamed Macki, Sharath Kumar Anand, Mohamed A Abouelleil, Jibran A Fateh, Jonathan W Rick, Ramin A Morshed, Hansen Deng, Kai-Yuan Chen, Adam Robin, Ian Y Lee, Steven Kalkanis, Dean Chou, Paul Park, Daniel M Sciubba, and Victor Chang.
• Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan.
• Neurosurgery. 2020 Oct 15; 87 (5): 1025-1036.

BackgroundNovel methods in predicting survival in patients with spinal metastases may help guide clinical decision-making and stratify treatments regarding surgery vs palliative care.ObjectiveTo evaluate whether the frailty/sarcopenia paradigm is predictive of survival and morbidity in patients undergoing surgery for spinal metastasis.MethodsA total of 271 patients from 4 tertiary care centers who had undergone surgery for spinal metastasis were identified. Frailty/sarcopenia was defined by psoas muscle size. Survival hazard ratios were calculated using multivariate analysis, with variables from demographic, functional, oncological, and surgical factors. Secondary outcomes included improvement of neurological function and postoperative morbidity.ResultsPatients in the smallest psoas tertile had shorter overall survival compared to the middle and largest tertile. Psoas size (PS) predicted overall mortality more strongly than Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). PS predicted 90-d mortality more strongly than Tokuhashi score, Tomita score, and KPS. Patients with a larger PS were more likely to have an improvement in deficit compared to the middle tertile. PS was not predictive of 30-d morbidity.ConclusionIn patients undergoing surgery for spine metastases, PS as a surrogate for frailty/sarcopenia predicts 90-d and overall mortality, independent of demographic, functional, oncological, and surgical characteristics. The frailty/sarcopenia paradigm is a stronger predictor of survival at these time points than other standards. PS can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.Copyright © 2020 by the Congress of Neurological Surgeons.

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