• Khaled Dibs, Benjin Facer, Prasath Mageswaran, Raju Raval, Evan Thomas, Emile Gogineni, Sasha Beyer, Jeff Pan, Brett Klamer, Ahmet Ayan, Eric Bourekas, Daniel Boulter, Nicholas Fetko, Eric Cochran, Ian Zoller, Vikram Chakravarthy, Esmerina Tili, J Bradley Elder, Russel Lonser, Ahmed Elguindy, Soheil Soghrati, William Marras, John Grecula, Arnab Chakravarti, Joshua Palmer, and Dukagjin M Blakaj.
• Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA.
• Neurosurgery. 2024 Apr 1; 94 (4): 797804797-804.

Background And ObjectivesVertebral compression fracture (VCF) is a common, but serious toxicity of spinal stereotactic body radiotherapy (SBRT). Several variables that place patients at high risk of VCF have previously been identified, including advanced Spinal Instability Neoplastic Score (SINS), a widely adopted clinical decision criterion to assess spinal instability. We examine the role of tumoral endplate (EP) disruption in the risk of VCF and attempt to incorporate it into a simple risk stratification system.MethodsThis study was a retrospective cohort study from a single institution. Demographic and treatment information was collected for patients who received spinal SBRT between 2013 and 2019. EP disruption was noted on pre-SBRT computed tomography scan. The primary end point of 1-year cumulative incidence of VCF was assessed on follow-up MRI and computed tomography scans at 3-month intervals after treatment.ResultsA total of 111 patients were included. The median follow-up was 18 months. Approximately 48 patients (43%) had at least one EP disruption. Twenty patients (18%) experienced a VCF at a median of 5.2 months from SBRT. Patients with at least one EP disruption were more likely to experience VCF than those with no EP disruption (29% vs 6%, P < .001). A nomogram was created using the variables of EP disruption, a SINS of ≥7, and adverse histology. Patients were stratified into groups at low and high risk of VCF, which were associated with 2% and 38% risk of VCF ( P < .001).ConclusionEP disruption is a novel risk factor for VCF in patients who will undergo spinal SBRT. A simple nomogram incorporating EP disruption, adverse histology, and SINS score is effective for quickly assessing risk of VCF. These data require validation in prospective studies and could be helpful in counseling patients regarding VCF risk and referring for prophylactic interventions in high-risk populations.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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