Comparative Analysis of Surgical Outcomes in Separation Surgery vs. Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression

Study Design. Retrospectively matched case-control study. Objective. To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC). Summary of Background Data. The primary goal of surgery for MESCC is to preserve and improve neurological function. Separation surgery may offer a less invasive alternative that still achieves neurological decompression and restores biomechanical stability, enabling surgeons to forego more invasive surgeries, such as corpectomy with anterior reconstruction. However, there is limited literature comparing these two surgical methods. Materials and Methods. Fifty-six patients aged 18 years or older who underwent either separation surgery followed by stereotactic body radiation therapy (n=28) or corpectomy with anterior reconstruction (n=28) for MESCC from 2017 to 2022 were included. Outcomes included estimated blood loss, operating time, intraoperative blood transfusion, and complications. The Mann-Whitney U test was used for continuous data, and the Fisher exact test for categorical data. Results. Patients undergoing separation surgery compared with anterior reconstruction experienced less blood loss [median 500 mL (IQR: 300-1000) vs. 925 mL (IQR: 500-1425); P=0.036] and shorter operating times [median 214 min (IQR: 164-281) vs. 286 min (IQR: 220-328); P=0.028]. Intraoperative blood transfusion occurred in 7 patients (25%) in the separation surgery group versus 14 patients (50%) in the anterior reconstruction group (P=0.10). There were no significant differences between both groups with regard to duration of hospitalization, complications, postoperative blood transfusion, reoperations, or survival (P<0.05). Conclusion. Separation surgery was found to have less blood loss and shorter operating times compared with corpectomy with anterior reconstruction. These findings suggest that separation surgery may be a viable therapeutic alternative for MESCC patients currently undergoing more invasive surgical approaches. Future studies should prospectively compare separation surgery and corpectomy with anterior reconstruction to provide additional evidence on their relative effectiveness in managing local tumor control. Level of Evidence: Level IV - treatment benefits.