Risk factors for early pathological fracture following stereotactic body radiation therapy for spinal metastases

作者：Juliana C. Capp, Zach Pennington, Abdelrahman M. Hamouda, Anthony L. Mikula, Nikita Lakomkin, Arjun S. Sebastian, Brett A. Freedman, Peter S. Rose, S. Mohammed Karim, Ahmad Nassr, Mohamad Bydon, William E. Krauss, Jeremy L. Fogelson, Roman O. Kowalchuk, Kenneth W. Merrell, Michelle J. Clarke, Benjamin D. Elder · 发表于：Neurosurgical FOCUS · 年份：2025 · DOI：10.3171/2025.2.focus24905 · 被引用次数：3 · 研究领域：Management of metastatic bone disease、Spinal Fractures and Fixation Techniques、Spine and Intervertebral Disc Pathology

OBJECTIVE: The aim of this study was to determine independent risk factors for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) in metastatic spine disease. METHODS: Patients treated with SBRT for spinal metastasis at a single tertiary care center between 2008 and 2019 were retrospectively identified. Patients with CT scans obtained within 1 year of SBRT completion were included. Variables collected included demographics, Spine Instability Neoplastic Score (SINS), primary tumor pathology, Weinstein-Boriani-Biagini (WBB) classification, chemoradiation treatment details, and bone quality as assessed by Hounsfield units (HUs) on CT. HUs were measured for the medullary bone of the metastatic level, the tumor, and the vertebral bodies cephalad and caudal to the metastasis. Multivariable logistic regression was used to identify predictors of post-SBRT pathological fracture. RESULTS: A total of 292 patients (mean age 66 years) with 392 unique lesions were included. The most common pathologies were prostate (n = 193), kidney/renal cell (n = 46), and lung (n = 33). The most common tumor levels were thoracic (n = 206 lesions) and lumbar (n = 128 lesions). SBRT was generally delivered in 1-3 fractions with doses ranging from 16 to 24 Gy in 1 fraction and 24-36 Gy in 3 fractions. Of the 392 lesions, 73 suffered VCF: 21 (29%) with < 25% height loss, 15 (21%) with 25%-40% height loss, and 37 (51%) with > 40% height loss. On univariate analysis, pati...