Original Article

Radiotherapy after surgery for spinal metastasis is associated with superior neurological improvement as compared to surgery alone

¹ Department of Surgical Sciences, Orthopaedics, Uppsala University, Akademiska sjukhuset, ingång 61, 6 tr 751 85 Uppsala, Sweden
² Department of Molecular Medicine and Surgery, Karolinska Institute, K1 Molekylär medicin och kirurgi, K1 MMK Ortopedi, 171 76 Stockholm, Sweden
³ Department of Acute and Reparative Medicine, Karolinska University Hospital, K1 Molekylär medicin och kirurgi, K1 MMK Ortopedi, 171 76 Stockholm, Sweden

^* Corresponding author: mikael.kontakis@gmail.com

Received: 5 March 2025
Accepted: 17 April 2025

Abstract

Introduction: Treatment of spinal metastases is multidisciplinary, where radiotherapy (RT) and surgery have a central role. The effect of adjuvant post-operative RT versus surgery alone for metastatic spinal disease has not been previously investigated. Our aim was to analyze whether post-operative RT was associated with better functional outcome or increased incidence of local complications after surgical treatment for spinal metastatic disease. Methods: Information on neurologic outcome of 200 patients surgically treated for spinal metastases was retrieved from the institutional registry. The events of pre-operative and post-operative neurological function, post-operative wound complications as well as death and implant revision were available. Results: Post-operative RT was significantly associated to superior neurological recovery, evaluated both as restoration of the ambulatory capacity and absolute change in the Frankel score. At the same time, use of post-operative RT was not associated to an increased risk of wound complications. The risk for revision surgery when RT was administered was similar to surgery alone in a competing risks analysis with death as the competing event. Discussion: The results indicate that surgery with post-operative RT is associated with superior neurologic recovery than surgery alone. The results also do not indicate any significant risk for wound healing problems with administered post-operative RT.