Hybrid therapy versus Total En Bloc Spondyectomy in the treatment of Solitary Radioresistant Spinal Metastases：A propensity score-matched analysis

Abstract Background Both hybrid therapy (HT) and total en bloc spondylectomy (TES)can lead to good results for solitary radioresistant metastatic spinal tumors with high-grade epidural spinal cord compression (ESCC). However, there is still a lack of comparative studies on the treatment efficacy of these two methods. Methods We retrospectively reviewed patients with the above-mentioned tumors between January 2012 and May 2019. A total of 157 patients underwent surgery, among whom 64 received HT, and 93 were treated with TES. Propensity score matching allowed the generation of best-matched pairs for the 2 categories (1:1 ratio). Local control rates and survival rates were estimated using the Kaplan–Meier method. Results All patients received a minimum of 2-year follow-up. The longest follow-up time was 88 months. The survival rates and local progression-free survival rates after HT were comparable with TES at 1 year (84.6% vs. 83.1%; 90.2% vs. 90%), 2 year (60.8% vs. 64.3%; 64.1% vs. 62.1%), and 5 year (18.8% vs. 24.1%; 24.4% vs. 28.4%). There were no significant differences in pain control, improvement of neurological status, spine stabilization restoration, and improvement in quality of life between groups. However, HT showed more advantages in shortening operative time and reducing intraoperative blood loss than TES. Conclusion Our results suggest that HT can obtain satisfactory results comparable to TES for solitary radioresistant metastatic spinal tumors with high-grade ESCC. In addition, compared with TES, HT has the advantages of shortening operative time and reducing perioperative complications. For solitary radioresistant metastatic spinal tumors with a high degree of ESCC, HT may be a promising treatment in the future.