Measuring the Delay in the Referral of Unstable Vertebral Metastasis to the Spine Surgeon: A Retrospective Study in a Latin American Institution

The delay in the referral of patients with potential surgical vertebral metastasis (VM) to the spine surgeon is strongly associated with a worse outcome. The spinal instability neoplastic score (SINS) allows for determining the risk of instability of a spine segment with VM; however, it is almost exclusively used by specialists or residents in neurosurgery or orthopedics. The objective of this work is to report the delay in surgical consultation of patients with potentially unstable and unstable VM (SINS >6) at our center. We performed a 5-year single-center retrospective analysis of patients with spine metastasis on computed tomography (CT). Patients were divided into Group 1 (G1), potentially unstable VM (SINS 7-12), and Group 2 (G2), unstable VM (SINS 13-18). Time to surgical referral was calculated as the number of days between the report of the VM in the CT and the first clinical assessment of a spinal surgeon on the medical records. We analyzed 220 CT scans, and 98 met the selection criteria. Group 1 had 85 patients (86.7%) and Group 2 had 13 (13.3%). We observed a mean time to referral of 83.5 days in the entire cohort (std = 127.6); 87.6 days (std = 135.1) for G1, and 57.2 days (std = 53.8) for G2. The delay in referral showed no significant correlation with the SINS score. We report a mean delay of 83.5 days in the surgical referral of VM (SINS >6, n = 98). Both groups showed cases of serious referral delay, with 25% of patients having the first surgical consultation more than three months after the CT study.