Objectives:To investigate the factors influencing intraoperative blood loss in spinal metastatic tu-mor surgery and provide scientific evidence for personalized surgical planning and blood loss control measures in clinical practice.Methods:We retrospectively analyzed the clinical data of 223 patients with spinal metastatic tumors treated at the Spinal Surgery Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2019 to September 2024.The surgical methods included vertebroplasty,tumor resection or partial resection,vertebral body reconstruction and internal fixation,and palliative surgery.Data collected included patient demographics(age,sex,BMI,etc.),tumor characteristics(primary tumor type,vertebral metastasis location and involvement area,number of extraspinal metastases,etc.),surgical factors(surgical ap-proach,robotic assistance,operative time,etc.),and intraoperative blood loss.Univariate regression analysis was conducted on each of the above indicators,and multivariate regression analysis was performed on the in-dicators with statistical significance to identify the influence of each factor on intraoperative blood loss.Re-sults:The intraoperative blood loss was 300mL(10,1000mL).Among the 223 patients,the proportion of metastasis in the thoracic and lumbar vertebrae was relatively high,and the blood loss was relatively signifi-cant in hypervascular tumors.The amount of blood loss in the tumor resection or partial resection and verte-bral body reconstruction and internal fixation groups was greater than that in the other two groups.Univariate analysis revealed that BMI(P＜0.001),primary tumor type(P＜0.001),vertebral metastasis location(P＜0.001),verte-bral involvement area(P＜0.001),number of extraspinal metastases(P=0.03),surgical approach(P＜0.001),robotic assistance(P＜0.001),and operative time(P＜0.001)were associated with intraoperative blood loss.Multivariate analysis identified BMI(P＜0.001),primary tumor type(P=0.02),vertebral metastasis location(P=0.02)and involve-ment area(P=0.004),surgical approach(P=0.04),and operative time(P＜0.001)as the independent predictors of intraoperative blood loss.Conclusions:Intraoperative blood loss in spinal metastatic tumor surgery is influ-enced by multiple factors,including BMI,primary tumor type,vertebral metastasis location and involvement area,surgical approach,and operative time.Sufficient preoperative evaluation shall be carried out,appropriate surgical approach shall be selected,and surgical techniques shall be improved to shorten operative time.

Objectives:To investigate the factors influencing intraoperative blood loss in spinal metastatic tu-mor surgery and provide scientific evidence for personalized surgical planning and blood loss control measures in clinical practice.Methods:We retrospectively analyzed the clinical data of 223 patients with spinal metastatic tumors treated at the Spinal Surgery Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2019 to September 2024.The surgical methods included vertebroplasty,tumor resection or partial resection,vertebral body reconstruction and internal fixation,and palliative surgery.Data collected included patient demographics(age,sex,BMI,etc.),tumor characteristics(primary tumor type,vertebral metastasis location and involvement area,number of extraspinal metastases,etc.),surgical factors(surgical ap-proach,robotic assistance,operative time,etc.),and intraoperative blood loss.Univariate regression analysis was conducted on each of the above indicators,and multivariate regression analysis was performed on the in-dicators with statistical significance to identify the influence of each factor on intraoperative blood loss.Re-sults:The intraoperative blood loss was 300mL(10,1000mL).Among the 223 patients,the proportion of metastasis in the thoracic and lumbar vertebrae was relatively high,and the blood loss was relatively signifi-cant in hypervascular tumors.The amount of blood loss in the tumor resection or partial resection and verte-bral body reconstruction and internal fixation groups was greater than that in the other two groups.Univariate analysis revealed that BMI(P＜0.001),primary tumor type(P＜0.001),vertebral metastasis location(P＜0.001),verte-bral involvement area(P＜0.001),number of extraspinal metastases(P=0.03),surgical approach(P＜0.001),robotic assistance(P＜0.001),and operative time(P＜0.001)were associated with intraoperative blood loss.Multivariate analysis identified BMI(P＜0.001),primary tumor type(P=0.02),vertebral metastasis location(P=0.02)and involve-ment area(P=0.004),surgical approach(P=0.04),and operative time(P＜0.001)as the independent predictors of intraoperative blood loss.Conclusions:Intraoperative blood loss in spinal metastatic tumor surgery is influ-enced by multiple factors,including BMI,primary tumor type,vertebral metastasis location and involvement area,surgical approach,and operative time.Sufficient preoperative evaluation shall be carried out,appropriate surgical approach shall be selected,and surgical techniques shall be improved to shorten operative time.

Objectives:To compare the short-term effectiveness and safety between robot-assisted cortical bone trajectory screw(CBTS)and traditional pedicle screw(TPS)fixations in posterior lumbar interbody fusion(PLIF)for lumbar spinal stenosis with osteoporosis.Methods:We retrospectively analyzed the clinical data of 113 patients who underwent robot-assisted PLIF and internal fixation in our hospital between September,2018 and June,2021.The patients were divided into two groups according to the internal fixation method.55 pa-tients fixed with CBTS were included in the CBTS group,and 58 patients fixed with TPS were included in the TPS group.The general data[age,sex ratio,height,weight,body mass index(BMI),hip bone mineral densi-ty(BMD)],surgical related data(operative time,incision length,intraoperative blood loss),perioperative indicators(postoperative length of hospital stay,surgical complications,screw loosening rate,adjacent facet joint violation rate,preoperative and postoperative blood glucose),and visual analogue scale(VAS)score of pain and Oswestry disability index(ODI)before and after surgery were recorded and compared.Results:There was no significant difference in age,sex ratio,height,weight,BMI and hip BMD between the two groups(P＞0.05).There was no significant difference in operative time,postoperative length of hospital stay,surgical complications,preoperative VAS score and ODI,and ODI at 1 month and 6 months after operation between the two groups(P＞0.05).The intraoperative blood loss,length of incision and VAS score at 6 months after operation in the CBTS group were significantly lower than those in the TPS group(500mL vs 600mL,P=0.007;8cm vs 10cm,P=0.006;2 vs 3,P＜0.001).There was no significant difference in blood glucose before operation and 1 day after operation between the two groups(P＞0.05),while at 1 week after operation,the CBTS group was significantly lower than the TPS group(4.75mmol/L vs 5.57mmol/L,P=0.041).At the final follow-up,the rates of screw loosening and adjacent facet joint violation in CBTS group were significantly lower than those in TPS group(1.68％vs 4.52％,P=0.044 and 13.83％vs 26.53％,P=0.029).Conclusions:For patients with lumbar spinal stenosis combined with osteoporosis,PLIF with robot-assisted CBTS fixation is less in surgical trauma,faster in early postoperative recovery,and fewer in screw-related complications than with TPS fixation.

Objectives:To compare the short-term effectiveness and safety between robot-assisted cortical bone trajectory screw(CBTS)and traditional pedicle screw(TPS)fixations in posterior lumbar interbody fusion(PLIF)for lumbar spinal stenosis with osteoporosis.Methods:We retrospectively analyzed the clinical data of 113 patients who underwent robot-assisted PLIF and internal fixation in our hospital between September,2018 and June,2021.The patients were divided into two groups according to the internal fixation method.55 pa-tients fixed with CBTS were included in the CBTS group,and 58 patients fixed with TPS were included in the TPS group.The general data[age,sex ratio,height,weight,body mass index(BMI),hip bone mineral densi-ty(BMD)],surgical related data(operative time,incision length,intraoperative blood loss),perioperative indicators(postoperative length of hospital stay,surgical complications,screw loosening rate,adjacent facet joint violation rate,preoperative and postoperative blood glucose),and visual analogue scale(VAS)score of pain and Oswestry disability index(ODI)before and after surgery were recorded and compared.Results:There was no significant difference in age,sex ratio,height,weight,BMI and hip BMD between the two groups(P＞0.05).There was no significant difference in operative time,postoperative length of hospital stay,surgical complications,preoperative VAS score and ODI,and ODI at 1 month and 6 months after operation between the two groups(P＞0.05).The intraoperative blood loss,length of incision and VAS score at 6 months after operation in the CBTS group were significantly lower than those in the TPS group(500mL vs 600mL,P=0.007;8cm vs 10cm,P=0.006;2 vs 3,P＜0.001).There was no significant difference in blood glucose before operation and 1 day after operation between the two groups(P＞0.05),while at 1 week after operation,the CBTS group was significantly lower than the TPS group(4.75mmol/L vs 5.57mmol/L,P=0.041).At the final follow-up,the rates of screw loosening and adjacent facet joint violation in CBTS group were significantly lower than those in TPS group(1.68％vs 4.52％,P=0.044 and 13.83％vs 26.53％,P=0.029).Conclusions:For patients with lumbar spinal stenosis combined with osteoporosis,PLIF with robot-assisted CBTS fixation is less in surgical trauma,faster in early postoperative recovery,and fewer in screw-related complications than with TPS fixation.