Introduction: The age of patients requiring surgery for spinal metastasis, primarily those over 65, has risen due to improved cancer treatments. Surgical intervention targets acute neurological deficits and instability. Anticoagulants are increasingly used, especially in the elderly, but pose challenges in managing bleeding complications. The study examines the correlation between preoperative anticoagulant/antiplatelet use and bleeding risks in spinal metastasis surgery, which is crucial for optimizing patient outcomes. Material and Methods: In a retrospective study at our department from 2010 to 2023, spinal tumor surgery patients were analyzed. Data included demographics, neurological status, surgical procedure, preoperative anticoagulant/antiplatelet use, intra-/postoperative coagulation management, and the incidence of rebleeding. Coagulation management involved blood loss assessment, coagulation factor administration, and fluid balance monitoring post-surgery. Lab parameters were documented at admission, preop, postop, and discharge. Results: A cohort of 290 patients underwent surgical treatment for spinal metastases, predominantly males (63.8%, n = 185) with a median age of 65 years. Preoperatively, 24.1% (n = 70) were on oral anticoagulants or antiplatelet therapy. Within 30 days, a rebleeding rate of 4.5% (n = 9) occurred, unrelated to preoperative anticoagulation status (p > 0.05). A correlation was found between preoperative neurologic deficits (p = 0.004) and rebleeding risk and the number of levels treated surgically, with fewer levels associated with a higher incidence of postoperative bleeding (p < 0.01). Conclusions: Surgical intervention for spinal metastatic cancer appears to be safe regardless of the patient’s preoperative anticoagulation status. However, it remains imperative to customize preoperative planning and preparation for each patient, emphasizing meticulous risk–benefit analysis and optimizing perioperative care.

Study Design.: A biomechanical study of 10 human thoracolumbar (T7–L2) spine specimens was performed. Objective.: To analyze the biomechanical characteristics of a Tether pedicle screw (TPS) in long-segment thoracolumbar instrumentation in terms of proximal junction mechanics and transitional motion patterns. Background.: Adult spinal deformity correction carries a high junctional failure risk. A soft-landing construct at a rigid construct cranial end might reduce the proximal junctional kyphosis and proximal junctional failure risks. Therefore, a novel TPS was designed to mitigate the proximal junctional kyphosis/proximal junctional failure risk. The pedicle screw is characterized by a tether between the threaded shaft and the screw head, enabling motion among parts. Materials and Methods.: For initial flexibility tests, 3 instrumentation patterns were tested. Representing conventional instrumentation, standard thoracolumbar pedicle screw-rod instrumentation at T10 to L2 was used [standard (STD) group]. The TPS was tested at T9 (TPS+1 group), 1 level above the upper instrumented vertebra, and at T9 and T8 (TPS+2 group). Flexibility tests (±5 Nm) in all 3 motion directions were performed and repeated after cyclic loading (250 cycles, 1–10 Nm). Finally, specimens in the STD and TPS groups were subjected to screw pull-out testing at the index level to analyze the TPS stress-shielding effects. Results.: The TPS+2 group demonstrated the largest range of motion decrease at T9 to T10 in the flexibility tests, with a smaller effect in the second adjacent segment at T8 to T9. No significant change in range of motion was observed in the uppermost segment (T7–T8) among all instrumentation pattern studies. Pull-out testing revealed greater mean forces at the T10 end-level in the TPS+2 group than in the STD group. Conclusion.: The TPS effectively distributed the loads across 3 adjacent levels and softened the load transition compared with the rigid construct. The TPS also showed the potential to stress-shield the upper instrumented vertebra (T10) and reduce the end-level screw loosening risk.