A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large prospective patient database to personalise surgical management.

Aim: Surgery for spinal metastases can improve symptoms, but sometimes complications can negate the benefits. Operations may have different indications, complexities and risks, and the choice for an individual is a tailor-made personalised decision. Previous prognostic scoring systems are becoming out of date and inaccurate.

Loss of Local Tumor Control After Index Surgery for Spinal Metastases: A Prospective Cohort Study.

Background: As survival after treatment for symptomatic spinal metastases increases, the incidence of local tumor recurrence also may increase. However, data regarding incidence and timing of recurrence or duration of survival after second surgeries are not readily available and may help to inform clinicians when to perform second surgeries.

Objective: To identify features associated with loss of local control (LLC) at a previously treated or new spinal level.

Learning to make better clinical decisions.

To achieve the optimum patient outcome one must be able to choose the most appropriate course of action. How this choice is made may not be actively contemplated, and there may be many unrecognized pitfalls for the unwary. An increased awareness of how we think should increase both the efficiency and success of clinical decision making.

Cord monitoring changes and segmental vessel ligation in the "at risk" cord during anterior spinal deformity surgery.

Study Design: Retrospective analysis of all cases of anterior spinal deformity surgery that had intraoperative spinal cord monitoring (somatosensory-evoked potentials, SSEPs).

Objectives: The prime purpose of this study was to determine the incidence of significant SSEP changes in patients undergoing anterior spinal deformity surgery. A secondary objective was to ascertain if patients with "cords at risk" were more likely to produce significant intraoperative SSEP changes and what proportion of these changes resulted in postoperative neurological deficit.