Surgical management of spinal metastases: A cross-continental study in the United States and the Netherlands

Background: There is currently no consensus on the optimal surgical treatment for patients with spinal metastases. Investigating regional variations in surgical management could provide valuable insights to optimize care and refine surgical practices globally. Objective: To investigate differences in patient populations, surgical management, and perioperative outcomes among patients who underwent surgery for spinal metastases in either Boston (United States) or Utrecht (Netherlands). Methods: 727 patients surgically treated for spinal metastases in Boston (n=539) and Utrecht (n=188) between 2018–2022 were included. Data on patient characteristics, surgical management, perioperative outcomes, and survival were collected. The Mann-Whitney U test was used for continuous data, and Fisher's exact test for categorical data. Results: In Boston, a higher percentage of patients had three or more spinal metastases (68% vs 59%; p=0.006) and brain metastases (16% vs 4.3%; p<0.001) at the time of surgery compared with Utrecht. Vertebrectomy/corpectomy with stabilization was performed in 54% of patients in Boston versus none in Utrecht (p<0.001), whereas percutaneous stabilization was performed in 1.3% of patients in Boston versus 39% in Utrecht (p<0.001). In Utrecht, patients received postoperative radiotherapy more frequently (70% vs 54%; p<0.001) and earlier (17 days [IQR:12–24] vs 29 days [IQR:23–39]; p<0.001). Postoperative neurological outcome, complications, reoperation rates, and survival did not differ between the two cohorts (all p>0.05). Conclusions: Differences in patient populations and surgical management exist between tertiary hospitals on separate continents. Further research is needed to determine the optimal extent and timing of surgery to improve quality of life for patients with spinal metastases.