Background/Objectives: Spinal metastases are a common and severe complication of lung cancer, particularly in small cell lung cancer (SCLC), and are associated with poor survival. Despite advancements in treatment, optimal management strategies remain unclear, with significant differences between non-small cell lung cancer (NSCLC) and SCLC. This study evaluates treatment patterns, survival outcomes, and prognostic factors in lung cancer patients with spinal metastases, integrating deep learning survival prediction models. Methods: This retrospective cohort study analyzed the National Cancer Database (NCDB) to identify NSCLC and SCLC patients diagnosed with spinal metastases. Demographics and treatment modalities were analyzed and adjusted for age, sex, and comorbidities. Kaplan–Meier analysis and Cox proportional hazards models assessed overall survival (OS). Five advanced survival prediction models estimated 1-year and 10-year mortality, with feature importance determined via permutation analysis. Results: Among 428,919 lung cancer patients, 5.1% developed spinal metastases, with a significantly higher incidence in SCLC (13.6%) than in NSCLC (5.1%). SCLC patients had poorer OS. Radiation therapy alone was the predominant treatment, and stereotactic body radiation therapy (SBRT) predicted better short- and long-term survival compared to other radiation techniques. High-dose radiation (71–150 Gy BED) improved OS in NSCLC, while reirradiation benefited NSCLC but had a limited impact in SCLC. SurvTrace demonstrated the highest predictive accuracy for 1-year and 10-year mortality, identifying age, radiation dose, reirradiation, and race as key prognostic factors. Conclusions: The management of spinal metastases requires a histology-specific approach. Radiation remains the primary treatment, with SBRT predicting better short- and long-term survival. High-dose radiation and reirradiation should be considered for NSCLC, while the benefits are limited in SCLC. These findings support histology-specific treatment strategies to improve survival of patients with metastatic lung cancer to the spine.

BACKGROUND AND OBJECTIVES: Spinal glomus arteriovenous malformations are rare intramedullary vascular lesions that can cause progressive myelopathy. Treatment strategies include microsurgical resection, endovascular embolization, and stereotactic radiosurgery. However, comparative effectiveness data remain limited, and previous meta-analyses are outdated. This study systematically compares the clinical and radiographic outcomes of surgery, embolization, and radiosurgery in the treatment of spinal glomus arteriovenous malformations. METHODS: A systematic review and meta-analysis were conducted in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Four electronic databases were searched for English-language reports with ≥3 patients and intervention-specific outcome data. Pooled proportions were calculated using random-effects models for 4 endpoints: (1) complete nidus obliteration, (2) partial obliteration, (3) neurologic symptom improvement, and (4) treatment-related complications. Subgroup analyses compared surgery with vs without preoperative embolization. Meta-regression evaluated temporal trends in treatment efficacy. RESULTS: Thirty-six studies comprising 462 patients were included. Patients underwent surgery (51%), embolization (35%), or radiosurgery (14%). Complete obliteration was most likely to occur after surgery (77%), compared with embolization (39%) and radiosurgery (16%) ( P < .001). No significant differences were found between treatment modalities in partial obliteration ( P = .19), symptom improvement ( P = .94), or complication rates ( P = .35). Among surgical patients, preoperative embolization did not affect the rate of complete obliteration ( P = .55). Meta-regression demonstrated an increase in complete obliteration rates after embolization over time. CONCLUSION: A surgical strategy (resection ± preoperative embolization) yielded the highest obliteration rate in selected, typically compact lesions, without an increased risk of complications compared with embolization or radiosurgery. These rates, particularly for radiosurgery, may increase with longer follow-up lengths. Improvements in embolization techniques over time suggest a growing role for endovascular therapy, particularly as an adjunct to surgery. However, heterogeneity in lesion classification limits the ability to draw definitive treatment recommendations. Standardized diagnostic and outcome reporting frameworks are needed to guide future studies.

BACKGROUND AND OBJECTIVES: Robotic-assisted spine surgery (RASS) has demonstrated significant advantages in adult spinal surgery, including improved screw placement accuracy, reduced radiation exposure, and decreased perioperative morbidity. However, its adoption in pediatric spinal surgery remains limited, with unclear evidence regarding its safety, efficacy, and clinical outcomes. This study evaluates institutional outcomes of RASS in pediatric patients and systematically reviews the literature to assess its utilization trends, perioperative outcomes, and complication rates. METHODS: A retrospective review was conducted on pediatric patients (<21 years of age) who underwent RASS at the Johns Hopkins Hospital between 2019 and 2023. Demographic, clinical, radiological, and surgical data were collected. A systematic review and meta-analysis up to March 2025 was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled estimates were generated using random-effects models, and meta-regression assessed temporal trends in utilization and outcomes. RESULTS: Seven pediatric patients underwent RASS at our institution, with a mean age of 18.4 ± 3.2 years. Across the literature, 900 pediatric patients (mean age: 15.1 ± 0.9 years) were identified. The most common indication was adolescent idiopathic scoliosis (59.6%). Among 11 434 pedicle screws analyzed, the overall accuracy was 97.2% ± 3.64%, with a malposition rate of 2.67% ± 3.61% and a revision rate of 0.79% ± 0.51%. The institutional screw accuracy was 91.7%, with 1 intraoperative revision (2.4%). The pooled mean operative time was 324.1 ± 62 minutes, and the estimated blood loss was 577.4 ± 346.6 mL. Institutional patients had lower mean estimated blood loss (145.71 ± 185.08 mL) and 2 postoperative complications. Meta-regression showed improving screw accuracy and decreasing durotomy rates over time. CONCLUSION: RASS in pediatric patients demonstrates high screw accuracy and low complication rates. Further studies are needed to optimize outcomes and guide standardized pediatric implementation.

Objectives: This study aims to identify clinical characteristics and biomarkers influencing survival outcomes in colorectal cancer (CRC) patients with spinal metastases. Methods: We conducted a retrospective cohort study involving 27 patients treated for CRC-derived spinal metastases at Johns Hopkins Hospital. Data on demographics, biomarker profiles of the primary colorectal tumor site, surgical outcomes, and survival were collected. Neurological function was assessed pre- and postoperatively using Frankel scores. Survival outcomes included overall survival (OS) and post-metastasis survival. Results: The median age of the patients was 58 years, with 63% being women. The sacral spine was the most frequently involved site (59.3%), followed by the thoracic and lumbar regions. Most patients (89%) already had extraspinal metastases, predominantly in the lungs. Biomarker analysis showed microsatellite stability in 63% of patients and CDX2 (Caudal-type homeobox 2) expression in 37%. Laminectomy was performed in 85% of cases and sacrectomy in 55.6%, leading to postoperative improvements in ambulatory function and neurological status. The main indications included local recurrence of the tumor and neurological deficits attributed to the impinging tumor. The median overall survival was 4.9 years, while the median post-metastasis survival was 3.0 years. Univariable analysis revealed that CK20 expression (p = 0.041) and spinal tumor recurrence (p = 0.045) were significantly associated with shorter post-metastasis survival. Conclusions: This study highlights the prognostic importance of CK20 expression and spinal tumor recurrence in CRC patients diagnosed with spinal metastases. Surgical intervention significantly improved neurological outcomes, enhancing patient quality of life. Further research with larger cohorts is needed to confirm these findings and optimize treatment strategies for this challenging patient population.