Surgical Decompression and Stabilization for Spinal Metastases: A Systematic Review of Functional and Quality-of-Life Outcomes.

Introduction: Spinal metastases are common in patients with advanced cancer and often lead to debilitating pain, neurological deficits, and spinal instability. Methods: A systematic review will be conducted following PRISMA guidelines in PubMed and Scopus databases without a time filter. An advanced search in Boolean logic was used and original studies in English, French, and German were included. These should report on the outcomes of surgical decompression and stabilization in adult patients with spinal metastases. Primary outcomes will include neurological improvement, pain reduction, and quality of life. Secondary outcomes will include overall survival and treatment-related complications. Case reports, reviews, systematic reviews, letters to the editor, grey literature, or annals from congresses will be excluded. Objective: To evaluate the efficacy of surgical decompression and stabilization in improving neurological function, pain control, and quality of life in patients with spinal metastases, compared to non-surgical treatments such as radiotherapy alone. Results: The initial search yielded a total of 62 studies (24 and 38 articles from Pubmed and Scopus, respectively). After screening titles and abstracts, 12 duplicates were removed, and 50 full-text studies were screened. Surgical decompression often results in significant neurological improvements in the American Spinal Injury Association (ASIA) and Frankel grades. A major benefit is also the reduction in pain levels, and additionally there is an improvement in the health-related quality of life (HRQOL), sustained up to one year post-surgery. Conversely, radiotherapy alone provides temporary improvement in pain scores, with no significant long-term changes in HRQOL. Conclusions: Surgical decompression and stabilization, often followed by radiotherapy, offer significant functional and quality-of-life benefits for patients with spinal metastases. While surgery provides more substantial and sustained improvements compared to radiotherapy alone, it requires careful selection of patients and meticulous consideration of patient-specific factors and timely integration of therapies.