Hardware Failure in Spinal Tumor Surgery: A Hallmark of Longer Survival?

Objective: Instrumentation failure in spine tumor surgery is a common reason for revision operation. Increases in patient survival demand a better understanding of the hardware longevity. The study objective was to investigate risk factors for instrumentation failure re-quiring revision surgery in patients with spinal tumors. Methods: A retrospective cohort from a single tertiary care specialty hospital from January 2005 to January 2021, for patients with spinal primary or metastatic tumors who under-went surgical intervention with instrumentation. Demographic and treatment data were collected and analyzed. Kaplan-Meier analysis was performed for overall survival, and sep-arate univariate and multivariate regression analysis was performed. Results: Three hundred fifty-one patients underwent surgical intervention for spinal tumor, of which 23 experienced instrumentation failure requiring revision surgery (6.6%). Multi-variate regression analysis identified pelvic fixation (odds ratio [OR], 10.9), spinal metasta-sis invasiveness index (OR, 1.11), and survival of greater than 5 years (OR, 3.6) as signifi-cant risk factors for hardware failure. One-and 5-year survival rates were 57% and 8%, re-spectively. Conclusion: Instrumentation failure after spinal tumor surgery is a common reason for re-vision surgery. Our study suggests that the use of pelvic fixation, invasiveness of the surgery, and survival greater than 5 years are independent risk factors for instrumentation failure.