# Clinical study of separation surgery combined with intraoperative vertebroplasty and 125I seeds implantation for spinal metastases from lung adenocarcinoma with epidural spinal cord compression

## TL;DR

A new surgical approach combining separation surgery, vertebroplasty, and radioactive seed implantation improves outcomes for lung cancer patients with spinal cord compression.

## Contribution

A novel combined surgical and radiological treatment for spinal metastases from lung adenocarcinoma is shown to enhance survival and quality of life.

## Key findings

- The SSVPI group showed better neurological recovery, pain relief, and performance status compared to the control group.
- SSVPI resulted in longer median overall survival (20 vs. 12 months) and improved progression-free survival.
- The SSVPI group had fewer complications and better local tumor control than the control group.

## Abstract

The study aim was to evaluate the efficacy and safety of separation surgery combined with intraoperative vertebroplasty and125I seeds implantation for the treatment of lung adenocarcinoma-associated metastatic epidural spinal cord compression (MESCC).

We retrospectively analyzed patients with lung adenocarcinoma spinal metastases who were treated for epidural spinal cord compression. Patients were divided into the SSVPI group (Separation surgery + vertebroplasty + 125I seeds implantation, n=48) and the control group (Decompression surgery involving separation, reconstruction, and fixation, n=48). At postoperative follow-up (1 week to 12 months), spinal cord function, pain, performance status, muscle strength, and health-related quality of life were assessed. Complications were recorded, and overall survival, progression-free survival, and local control were analyzed using Kaplan-Meier curves.

All 96 patients underwent the surgery successfully. The baseline characteristics showed no significant between the two groups. The SSVPI group demonstrated superior outcomes, with better neurological recovery(Higher International Standards for Neurological Classification of Spinal Cord Injury grade D improvement; >40% at 1/3/6 months, P<0.005). Pain relief (Faster visual analog scale pain score reduction;>60% decline within 2 months, P<0.001), and improved performance status (Earlier ECOG/KPS improvement;≥75% by 2 weeks). Quality of life, assessed by Quality of Life Questionnaire-Core 30 scores increased by 18.6 points at 3 months (P≤0.003).The SSVPI group also experienced longer median overall survival (20 vs. 12 months, P=0.026), progression-free survival (12 vs. 8 months), and local control (all P<0.05). The SSVPI group primarily experienced minor bone cement leakage (10.42%)), whereas the control group experienced complications predominantly related to tumor progression-associated secondary spinal cord compression (3 cases, 6.25%) and radiation therapy-related adverse events (total incidence: 39.6%), including radiation dermatitis (18.75%), osteonecrosis (16.67%), and spinal cord injury (4.17%).

SSVPI is an optimized treatment for lung adenocarcinoma-related MESCC. It provides immediate spinal cord decompression and stabilization, concurrent intraoperative 125I seeds implantation for early and sustained radiotherapy, and avoids delayed postoperative radiation and complications associated with external beam therapy. This approach enhances local tumor control while preserving neurological function and improving quality of life.