BACKGROUND CONTEXT: Choosing appropriate surgical patients in the setting of 
spinal metastases can be challenging. Existing scoring systems focus primarily 
on patient selection or operative techniques. These scores are limited in their 
capacity to predict postoperative survival.
PURPOSE: The aim was to model survival after spine surgery for metastastic 
disease.
STUDY DESIGN: This was a retrospective multicenter study.
PATIENT SAMPLE: All patients who had undergone surgery for the treatment of 
metastatic spinal disease at one of four tertiary care centers between 2007 and 
2013 were included.
OUTCOME MEASURE: The outcome measure was 1-year survival after surgery.
METHODS: Demographic, medical, oncologic, surgical, and survival data were 
abstracted from medical records. The effect of predictor variables on survival 
was evaluated alone and in combination using stepwise logistic regression. 
Multivariable logistic regression was subsequently used to adjust for 
confounders. A predictive score was then developed and compared against that of 
the modified Bauer score alone in terms of prognosticating 1-year survival after 
surgery.
RESULTS: In the time period under investigation, 318 patients underwent surgical 
intervention for metastastic disease involving the spine, with 307 having data 
available for analysis. The survival rate at 1 year was 48% (n=142), with a 
median survival of 10 months. In final adjusted analysis, preoperative modified 
Bauer score (odds ratio [OR] 3.00; 95% confidence interval [CI] 1.80-5.01; 
p<.001), ambulatory status (OR 2.47; 95% CI 1.48-4.14; p=.001), and serum 
albumin (OR 2.80; 95% CI 1.66-4.72; p<.001) were all independent predictors of 
1-year survival. The most parsimonious model weighted the modified Bauer score 
with 2 points and intact ambulatory status and normal serum albumin level with 1 
point each, with a ceiling score of 3. The final model using the predictive 
score was able to explain 74% of the variation in 1-year survival. In contrast, 
the modified Bauer score alone was only able to explain 64% of the variation in 
1-year survival.
CONCLUSIONS: This study demonstrates the importance of including factors related 
to the overall health of a patient, in addition to parameters surrounding their 
cancer diagnosis, to better prognosticate survival. Our predictive score 
performed better than the modified Bauer alone and may be used to predict 
survival after surgical intervention for metastatic disease.
LEVEL OF EVIDENCE: III.