Background: Disparities among patients with cancer are well documented. Recent studies suggest these disparities also affect patients undergoing metastatic spinal tumor surgery. However, it is unclear whether social factors are associated with ambulatory outcomes or overall survival. Questions/purposes: In patients undergoing metastatic spinal tumor surgery, (1) Are race, Social Vulnerability Index (SVI) score, or insurance status associated with a lower likelihood of postoperative ambulation? (2) Are race, SVI score, or insurance status associated with shorter overall survival? Methods: Between April 2012 and June 2021, we surgically treated 148 patients for metastatic cord compression or spinal mechanical instability because of cancer. Inclusion criteria were patients with complete demographic, social, oncologic, and follow-up data and patients who were followed until death or for at least 3 months postoperatively. Based on these criteria, 12% (18 of 148) were excluded because they had incomplete data and another 7% (11 of 148) were excluded because they were lost before the minimum study follow-up interval, leaving 80% (119) for analysis. Collected social data included self-reported race (White, Black, Hispanic or Latino, or other), SVI score, and primary insurance (Medicare, Medicaid, or private). The median age of the group was 62 years (interquartile range [IQR] 53 to 70 years), and 58% of patients were men (69 of 119). The race distribution was 45% Black (54 of 119), 32% Hispanic or Latino (38 of 119), 16% White (19 of 119), and 7% other (eight of 119). The median SVI score was 89.8 (IQR 73.8 to 98.5), and 74% of patients (88) were categorized as having high vulnerability. The insurance distribution was as follows: Medicare: 43%, Medicaid: 36%, and private insurance: 21%. The primary outcome variable was complete inability to ambulate postoperatively and the secondary outcome was median overall survival. Exploratory data analysis, univariate and multivariate logistic regression, and univariate and multivariate Cox regression analyses were performed. Results: After controlling for race, SVI score, insurance status, primary cancer, and modified Bauer score, the only factor independently associated with postoperative nonambulation was preoperative nonambulatory status (odds ratio 59.3 [95% confidence interval (CI) 13.2 to 266.1]; p < 0.001). After controlling for variables such as performance status, BMI, primary cancer, modified Bauer score, and insurance status, factors independently associated with survival included Eastern Cooperative Oncology Group performance status (hazard ratio [HR] 1.4 [95% CI 1.1 to 2.0]; p = 0.03), prostate cancer (HR 0.4 [95% CI 0.1 to 0.9]; p = 0.03), and hematologic cancer (HR 0.3 [95% CI 0.1 to 0.8]; p = 0.02). Race, SVI score, and insurance status were not associated with overall survival. Conclusion.: In this study, we found no difference in ambulatory outcome for patients based on their race, SVI score, or insurance status. Likewise, no differences in postoperative survival were found. These findings suggest that despite differences in presentation or short-term outcome reported in other investigations, the social factors we explored were not associated with the likelihood of a patient being nonambulatory postoperatively or shorter survival after spinal tumor surgery. Research studies that analyze race as a covariate of interest should take care to explore metrics of socioeconomic deprivation (such as the SVI score) to avoid drawing misleading conclusions. Level of Evidence: Level III, therapeutic study.

OBJECTIVE: Inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) have shown promise in predicting mortality in various types of cancer. The purpose of this study was to assess NLR, PLR, and SII in predicting 30-day mortality and overall survival (OS) among surgically treated patients with spinal metastasis. METHODS: This was a retrospective study including 153 patients who underwent surgery for spinal metastasis between 2012 and 2022. Electronic medical records were manually reviewed, and NLR, PLR, and SII were calculated from preoperative neutrophil, platelet, and lymphocyte counts. Receiver operating characteristic curves with areas under the curve were generated to determine cutoff values. Logistic regression was used to determine the odds ratios (ORs) for 30-day mortality. The Kaplan-Meier method and Cox regression were used to determine the hazard ratio (HR) for OS limited to 5 years postoperatively. RESULTS: Preoperative cutoff values were as follows: NLR > 10.2, PLR > 260, and SII > 2900. Overall, 35.9% (55/153) of patients had elevated NLR, 45.7% (70/153) had elevated PLR, and 30.7% (47/153) had elevated SII. The overall 30-day mortality was 8.5% (13/153). After controlling for confounders such as performance status and primary tumor type, high NLR (OR 5.20, 95% CI 1.21–22.28; p = 0.026) and SII (OR 4.92, 95% CI 1.17–20.63; p = 0.029) were associated with increased odds of 30-day postoperative mortality. The median OS time in the study population was 26 months (95% CI 12–40 months). After controlling for confounders such as Eastern Cooperative Oncology Group status, primary tumor, and hypoalbuminemia, high NLR was associated with shorter OS (HR 2.23, 95% CI 1.48–3.97; p = 0.003). CONCLUSIONS: High preoperative NLR and SII were independently associated with 30-day postoperative mortality in this study. Elevated NLR was also found to be associated with shorter OS. The prognostic role of these metrics warrants further investigation.

Adult degenerative scoliosis (ADS) is a coronal plane deformity often accompanied by sagittal plane malalignment. Surgical correction may involve the major and/or distally-located fractional curves (FCs). Correction of the FC has been increasingly recognized as key to ameliorating radicular pain localized to the FC levels. The present study aims to summarize the literature on the rationale for FC correction in ADS. Three databases were systematically reviewed to identify all primary studies reporting the rationale for correcting the FC in ADS. Articles were included if they were English full-text studies with primary data from ADS ( ≥ 18 years old) patients. Seventy-four articles were identified, of which 12 were included after full-text review. Findings suggest FC correction with long-segment fusion terminating at L5 increases the risk of distal junctional degeneration as compared to constructs instrumenting the sacrum. Additionally, circumferential fusion offers greater FC correction, lower reoperation risk, and shorter construct length. Minimally invasive surgery (MIS) techniques may offer effective radiographic correction and improve leg pain associated with foraminal stenosis on the FC concavity, though experiences are limited. Open surgery may be necessary to achieve adequate correction of severe, highly rigid deformities. Current data support major curve correction in ASD where the FC concavity and truncal shift are concordant, suggesting that the FC contributes to the patient’s overall deformity. Circumferential fusion and the use of kickstand rods can improve correction and enhance the stability and durability of long constructs. Last, MIS techniques show promise for milder deformities but require further investigation.

Hypoalbuminemia is associated with poor outcomes in cancer patients, but its role in spinal metastases remains unclear. This study aimed to identify albumin cutoff values defining hypoalbuminemia and describe the association between serum albumin and outcomes in patients with spinal metastases. A narrative review of articles up to December 2022 was conducted using PubMed/Medline, EMBASE, and Web of Science databases. Variables extracted included study design, patient characteristics, serum albumin levels, treatments, and levels of evidence. Outcomes included survival/mortality, complications, ambulatory status, readmission, length of stay, discharge disposition, and blood loss. Thirty-eight studies comprising 21,401 patients were analyzed. Most studies (92%) were Level of Evidence III. Albumin was evaluated as a continuous variable in 18% of studies and as a dichotomous variable in 76%, with 3.5 g/dL being the most common threshold for hypoalbuminemia. Primary outcomes evaluated were survival/mortality (71% of studies), complications (34%), and reoperation/readmission (11%). Of studies examining the association between hypoalbuminemia and survival/mortality, 74% found a significant association. An association between albumin levels and complications was found in 54% of relevant studies. The findings of this study suggest that a threshold of 3.5 g/dL seems most appropriate to define hypoalbuminemia in patients with spinal metastases. However, evidence also supports a level-dependent effect. The most consistent significant association was between low albumin and survival at both fixed and continuous time points. There is less evidence to support an association between hypoalbuminemia and other endpoints such as perioperative complications.

Endovascular therapy is known to achieve a high rate of recanalization in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) and is currently the standard of care. Hemorrhagic conversion is a severe complication that may occur following AIS in patients undergoing endovascular thrombectomy (EVT). There is a scarcity of data on the risk factors related to HV in post-EVT patients, especially those who develop symptomatic hemorrhagic conversion. The main objective of our study is to identify independent predictors of radiographic and symptomatic hemorrhagic conversion in our diverse patient population with multiple baseline comorbidities that presented with AIS and were treated with EVT as per the most updated guidelines and practices. This is a retrospective chart review in which we enrolled adult patients treated with EVT for AIS at a comprehensive stroke center in the Bronx, NY, over a four-year period. Bivariate analyses followed by multiple logistic regression modeling were performed to determine the independent predictors of all and symptomatic hemorrhagic conversion. A total of 326 patients who underwent EVT for AIS were enrolled. Of these, 74 (22.7%) had an HC, while 252 (77.3%) did not. In total, 25 out of the 74 (33.7%) patients were symptomatic. In the logistic regression model, a history of prior ischemic stroke (odds ratio (OR) = 2.197; 95% confidence interval (CI) = 1.062-4.545; p-value = 0.034), Alberta Stroke Program Early CT Score (ASPECTS) of <6 (OR = 2.207; 95% CI = 1.477-7.194; p-value = 0.019), and Thrombolysis in Cerebral Infarction (TICI) 2B-3 recanalization (OR = 2.551; 95% CI = 1.998-6.520; p-value=0.045) were found to be independent predictors of all types of hemorrhagic conversion. The only independent predictor of symptomatic hemorrhagic conversion on multiple logistic regression modeling was an elevated international normalized ratio (INR) (OR = 11.051; 95% CI = 1.866-65.440; p-value = 0.008). History of prior ischemic stroke, low ASPECTS score, and TICI 2B-3 recanalization are independent predictors of hemorrhagic conversion while an elevated INR is the only independent predictor of symptomatic hemorrhagic conversion in post-thrombectomy patients.