Spinal Stereotactic Radiosurgery (SSRS) Complications: Study Reveals Pathologic Fracture Risk

Strategic Insights -

Research from the University of Texas MD Anderson Cancer Center has shed light on the complications associated with spinal stereotactic radiosurgery (SSRS). A recent study of 67 patients who underwent SSRS between 2011 and 2020 found that 74.6% of the patients were men, and the most common tumor histologies were prostate adenocarcinoma and renal cell carcinoma. The study demonstrated that patients experiencing in-field progression were more likely to experience fracture, with a 61.5% vs 10.2% fracture rate in patients with and without in-field progression, respectively.

Key Takeaways:

  • The study included 67 patients who underwent SSRS between 2011 and 2020, with 50 (74.6%) being men and 17 (25.4%) being women.
  • The most common tumor histologies were prostate adenocarcinoma (23.9%) and renal cell carcinoma (17.9%).
  • Median age at treatment was 63 years, and the mean number of levels treated was 1.5 +/- 0.7 (1-4) levels.
  • Bone density at S1 was 208.0 +/- 74.4 (-3.0 to 443.3) Hounsfield units (HUs), and median follow-up was 16.6 months.
  • The 1-year local control rate was 83.6%, and 14 patients (20.9%) experienced fracture within the radiation field.
  • There was no association between fracture and patient sex, age, S1 HU, tumor location, presence of pain, single versus multifraction radiation, or number of levels treated.
  • Patients experiencing in-field progression were more likely to experience fracture (61.5% vs 10.2%, p = 0.001).
  • Pathologic fracture may occur after sacral SSRS in a significant number of patients and is significantly associated with failure of local control.

Statistics:

  • 67 patients underwent SSRS between 2011 and 2020.
  • 50 (74.6%) of the patients were men, and 17 (25.4%) were women.
  • The most common tumor histologies were prostate adenocarcinoma (23.9%) and renal cell carcinoma (17.9%).
  • 14 patients (20.9%) experienced fracture within the radiation field.
  • The 1-year local control rate was 83.6%.
  • Median follow-up was 16.6 months.
  • The mean number of levels treated was 1.5 +/- 0.7 (1-4) levels.
  • Bone density at S1 was 208.0 +/- 74.4 (-3.0 to 443.3) Hounsfield units (HUs).

Sources:

  • Journal of Neurosurgery: Spine, 2025;43(3):305-312.
  • Amer Assoc Neurological Surgeons, 5550 Meadowbrook Drive, Rolling Meadows, IL 60008, USA.
  • University of Texas MD Anderson Cancer Center, Dept. of Neurosurgery, Houston, TX, United States.
  • NewsRx LLC. Findings on Neurosurgery Discussed by Investigators at University of Texas MD Anderson Cancer Center (Sacral Fracture Risk After Stereotactic Spinal Radiosurgery: a Multi-institution, Retrospective Analysis). Medical Devices & Surgical Technology Week. November 2, 2025; p 529.