449 Carbon Fibre Versus Titanium Implant Construct in Separation Surgery with Post Adjuvant Stereotactic Ablative Radiotherapy for Spinal Oligometastatic Disease
P Saha, L Uthayanan, K Cox, E Tsang, Z Hwang, B Ajayi, U Khan, V Singh Alg, P Minhas, D Lui- Surgery
Abstract
Aim
Radical treatment for Spinal Oligometastatic Disease (OMD) was often traditionally treated with morbid Tomita En Bloc Spondylectomy. Now, Stereotactic Ablative Radiosurgery (SABR) provides curative tumour ablation without open surgery, reduced cord toxicity and better pain management. SABR delivered postoperatively to Separation Surgery (SS) has shown excellent mortality rates, infection control, maximum local-control, and better pain management. This study is the first to compare clinical safety of carbon-fibre implantation (CFI) comparing to titanium implantation (TI).
Method
Retrospective review of OMD/OPD cases that underwent separation surgery with postoperative SABR investigating tumour histology, OMD type, instrumentation used for SS (CFI versus TI), mortality, local recurrence (LR), pain management, infection, complications, hospital length of stay, ICU length of stay and palliative outcomes at a quaternary level-1 spinal unit.
Results
79 patients were in the OMD pathway, 36 patients underwent SS with/without SABR. 20 patients had SS with TI. 16 patients had SS with CFI. SS with TI±SABR: 30-day mortality-10%, 12-month mortality-15%. SS with TI+SABR: 30-day mortality-0% 12-month mortality-0%, 12-month LR-0% TI: Infection-4% SS with CFI±SABR: 30-day mortality-6%, 3-year mortality-12.5%. SS with CFI+SABR: 30-day mortality-0% 12-month mortality-0%, 12-month LR-0% CFI: Infection-0% Pain in both groups were associated with PD cases only.
Conclusions
SS with postoperative SABR regardless of construct material demonstrated excellent outcomes. CFI demonstrated to be superior to TI. When postoperative SABR was absent from treatment, patients had complications and was demoted to palliative decompression with neurological symptom management. This highlights the importance of SABR in conjunction to SS.