title: Is surgery for spine metastasis reasonable in patients older than 60 years?
abstract: BACKGROUND
  Spinal metastases are common in patients older than 60 years with cancer. Because of the uncertainty of survival and the high incidence of fatal complications, however, chemotherapy and radiotherapy generally have been considered preferable and surgery a treatment of last resort for these patients. Further, the selection criteria indicating surgery and reliable prognostic factors for survival remain controversial.
  
  
  OBJECTIVE
  We therefore assessed surgical complications, postoperative function, and risk factors affecting their overall survival.
  
  
  METHODS
  We retrospectively reviewed 92 patients 60 years or older (range, 60-81 years) who had surgery for spinal metastases. The surgical complications were recorded and a VAS pain score, Frankel grade, and Karnofsky score were obtained. Statistical analyses were performed to identify factors associated with survival. The minimum followup was 6 months (mean, 22 months; range, 6-78 months).
  
  
  RESULTS
  Surgical complications occurred in 21 patients. Pain levels decreased postoperatively in 90% of patients and neurologic function improved in 78%. The Karnofsky status improved in 58 patients giving an improvement rate of 63%. The overall survival rates at 1 year and 3 years were 61% and 35% with a median of 15 months. Primary tumor type and Tokuhashi score independently predicted survival in patients with spinal metastases.
  
  
  CONCLUSIONS
  Our findings suggest surgery for spinal metastasis can achieve pain relief, neurologic improvement, and restoration of general condition but with a high risk of complications. Primary tumor type and Tokuhashi scoring independently predicted survival in patients with spinal metastases after surgery.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery/Orthopaedic Research Institute, The First Hospital Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan 2nd Road, 510080, Guangzhou, China.
authors.forename: Tangzhao
authors.initials: T
authors.lastname: Liang
authors.forename: Yong
authors.initials: Y
authors.lastname: Wan
authors.forename: Xuenong
authors.initials: X
authors.lastname: Zou
authors.forename: Xinsheng
authors.initials: X
authors.lastname: Peng
authors.forename: Shaoyu
authors.initials: S
authors.lastname: Liu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome