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BACKGROUND CONTEXT: Metastatic spinal cord compression (MSCC) presents complex treatment dilemmas where predicting survival is crucial for clinical decision-making.

PURPOSE: The NewEngland Spinal Metastasis Score (NESMS) has shown promise, but external validation is needed to confirm its broader applicability. STUDY DESIGN: Patients were assigned NESMS retrospectively based on ambulatory status, serum albumin level, and modified Bauer score.

PATIENT SAMPLE: This retrospective multicentre study included 322 adult patients with radiologi cally confirmed MSCC who presented for initial treatment over a 3-year period at 2 partner institutions.

OUTCOMEMEASURES:Theprimaryoutcomewasmortality at 12 months, with secondary out comes of mortality at 3 and 6 months. METHODS: Kaplan-Meier survival analysis and multivariate logistic regression were used to evaluate NESMS performance in predicting mortality and its discriminative capacity, while adjust ing for potential confounders.

RESULTS: The cohort had a median age of 70 years, with 65% male patients. Overall 12-month mortality was 75%. NESMS demonstrated excellent discriminative capacity for predicting 12 month mortality (c-statistic 0.82, p<.001) with clear stepwise differences in survival between NESMS levels (mortality: NESMS 0=98%, NESMS 1=88%, NESMS 2=75%, NESMS 3=46%). Multivariate analysis confirmed significantly greater odds of mortality with decreasing NESMS (NESMS 0: OR 35.92, CI 6.90-662.6; NESMS 1: OR 6.97, CI 3.22-16.02; NESMS 2: OR 2.69, CI 1.35-5.42; all p<.05 compared to NESMS 3). Operative management was associated with signifi cantly lower mortality (OR 0.28, CI 0.15-0.51; p<.001). CONCLUSIONS: This study externally validates the usefulness of the NESMS in predicting sur vival for both operative and nonoperative patients with MSCC. Further, we observed clear stepwise increases in mortality with worsening NESMS.