Surgical Treatment in the Management of Spinal Metastasis: A Single-center Retrospective Observational Study

Abstract Advancements in cancer therapies have significantly prolonged patient survival, resulting in a growing number of individuals living with advanced disease. Consequently, the incidence of spinal metastases has increased, thereby posing a growing clinical challenge of diminished quality of life. This study aimed to evaluate survival outcomes in patients with spinal metastases with or without surgery, and the correlation with Tomita or Tokuhashi scores. This is a retrospective observational study of 188 patients who received radiotherapy for spinal metastases between December 2019 and February 2024 at a single tertiary center. Survival outcomes, including overall survival (OS) and post–bone metastasis survival (PBMS), were analyzed. Correlations between survival and Tomita or Tokuhashi scores and impact of treatment alignment with Tomita score recommendations were evaluated. Among the patients, 29.3% underwent surgical intervention. Patients who received surgery had significantly improved one-year OS (p < 0.001), and a trend toward longer PBMS (median: 14.8 vs. 6.5 months, p = 0.078). Tomita score was inversely correlated with PBMS but not with OS. In contrast, Tokuhashi score did not significantly correlate with either outcome. Treatment plans were consistent with Tomita score recommendations in 28.3% of cases. However, no survival benefit was observed for patients receiving Tomita-aligned strategies. Surgical intervention was associated with improved one-year survival among patients with spinal metastases receiving radiotherapy. The Tomita score demonstrated limited prognostic value and treatment recommendations adherence did not improve survival. These findings highlight the limitations of existing scoring systems and the need for individualized strategies in managing spinal metastases.