Abstract
Objective
To compare surgical outcomes between patients with spinal metastases who received surgical treatment concordant with the LORDS (life expectancy, operability, responsible segment, decompression, and stabilization) strategy and those who did not.Background
The Neurologic, Oncologic, Mechanical, and Systemic (NOMS) framework is widely used to guide decision-making in spinal metastases. With advances in targeted therapy, immunotherapy, and surgical techniques, more patients are now candidates for anterior column resection. However, a balanced surgical strategy that is compatible with NOMS framework and surgery remains lacking.Methods
We included 238 adult patients (≥18 years) with spinal metastases who underwent surgery between January 2018 and December 2022. Patients were categorized into the LORDS-concordant group (n = 129) and the non-concordant group (n = 109). The non-concordant group was further subdivided based on decompression extent into de-escalated (n = 37) and escalated (n = 72) subgroups. Surgical outcomes included blood loss, duration of surgery, change in Frankel grade, postoperative systemic therapy (chemotherapy, targeted therapy, immunotherapy, bone-modifying agents), radiotherapy, length of hospitalization, reoperation, complications, overall survival (OS), and local progression-free survival (LPFS).Results
Patients who underwent surgery in accordance with the LORDS strategy exhibited a higher proportion of both radioresistant and radiosensitive individuals, while the proportion of patients with undefined radiosensitivity was lower (p = 0.030). However, this baseline difference did not reach statistical significance in subgroup analysis (p = 0.102). Furthermore, the LORDS-concordant group experienced a shorter length of hospitalization compared to the non-concordant group (p = 0.004), with subgroup analysis confirming consistent results (p Conclusion
The LORDS strategy represents an exploratory surgical framework that integrates key clinical considerations while remaining compatible with the NOMS framework. It may offer a balanced and individualized approach to surgical decision-making in spinal metastases, with the potential to optimize outcomes without increasing operative risks. Further prospective validation of the LORDS strategy and refinement of its life-expectancy assessment are warranted.