RECOSAN Tumors Study: Analysis of Patients with Spine Surgery due to Oncologic Pathology

Author(s): Marcelo Molina, Oscar Ceballos, Mariana Pereira, Daniel Lobos, Ratko Yurac, Juan Pablo Otto, Maximiliano Barahona.

Introduction: Primary bone tumors of the spine are rare and account for 2.8 to 13% of all bone tumors. On the other hand, the spine is a frequent location for metastatic disease. As local control of the primary tumor pathology continues to improve, survival rates improve, and, by extension, the chance of metastasis increases. Breast, lung, and prostate cancer are the main causes of spinal metastases. The RECOSAN (Santiago Spine Surgery Registry) project is the first multicenter, prospective, and national registry of spinal surgeries in Chile.

Purpose: The objective was to describe the epidemiological, diagnostic, surgical information, complications, and biopsy results of patients operated on for tumor pathology in the RECOSAN registry.

Materials and methods: The RedCap Database of the RECOSAN project’s was used to obtain information on patients who underwent spinal surgery due to tumor pathology in five Chilean hospitals. Information on the biopsies of these patients was requested from the respective hospitals and clinics where they were admitted. Demographic data, surgical history, and results of biopsies performed were collected.

Results: Out of 1225 patients admitted to the registry, 82 correspond to spinal surgeries due to tumor pathology. Biopsy reports were obtained from 63 patients who underwent surgical biopsy plus tumor resection and instrumentation. 52% of the patients were male, and the mean age was 57 years. 44% of the biopsies were in the dorsal spine and 40% in the lumbar spine. Of the total number of biopsies performed, 84.1% resulted in tumor lesions. Of these, 66% corresponded to metastases and 34% to primary tumors. The most frequent histological diagnoses were breast carcinoma (20.8%), prostate carcinoma (11.3%) and plasma cell neoplasia (9.4%). The percentage of intraoperative complications of the instrumented patients was 18%, and the percentage of reoperation was 4.7%. There was agreement between the preoperative and final diagnoses based on the biopsy of 66% of the cases, reaching a moderate concordance (Kappa= 0.42).

Conclusion: Vertebral biopsy is an essential procedure for histological diagnosis in both primary and metastatic tumor lesions. This is the first national multicenter registry in Chile for patients undergoing surgery for tumors. It covers epidemiological data, clinical information, surgical techniques, biopsy results, as well as intraoperative and postoperative complications. In this series, the most frequent histological diagnoses coincide with those reported in the literature. The concordance between the preoperative diagnosis and the biopsy is moderate, which supports the importance of obtaining a biopsy for the treatment of spinal tumor pathology.