Factors affecting the prognosis of recovery of motor power and ambulatory function after surgery for metastatic epidural spinal cord compression

Abstract

OBJECTIVE Metastatic epidural spinal cord compression (MESCC) causes neurological deficits that may hinder ambulation. Understanding the prognostic factors associated with increased neurological recovery and regaining ambulatory functions is important for surgical planning in MESCC patients with neurological deficits. The present study was conducted to elucidate prognostic factors of neurological recovery in MESCC patients. METHODS A total of 192 patients who had surgery for MESCC due to preoperative neurological deficits were reviewed. A motor recovery rate ≥ 50% and ambulatory function restoration were defined as the primary favorable endpoints. Factors associated with a motor recovery rate ≥ 50%, regaining ambulatory function, and patient survival were analyzed. RESULTS About one-half (48.4%) of the patients had a motor recovery rate ≥ 50%, and 24.4% of patients who were not able to walk due to MESCC before the surgery were able to walk after the operation. The factors “involvement of the thoracic spine” (p = 0.015) and “delayed operation” (p = 0.041) were associated with poor neurological recovery. Low preoperative muscle function grade was associated with a low likelihood of regaining ambulatory functions (p = 0.002). Furthermore, performing the operation ≥ 72 hours after the onset of the neurological deficit significantly decreased the likelihood of regaining ambulatory functions (p = 0.020). Postoperative ambulatory function significantly improved patient survival (p = 0.048). CONCLUSIONS Delayed operation and the involvement of the thoracic spine were poor prognostic factors for neurological recovery after MESCC surgery. Furthermore, a more severe preoperative neurological deficit was associated with a lesser likelihood of regaining ambulatory functions postoperatively. Earlier detection of motor weaknesses and expeditious surgical interventions are necessary, not only to improve patient functional status and quality of life but also to enhance survival.

Does Preoperative Radiation Therapy Performed for Metastatic Spine Cancer at the Cervical Spine Increase Perioperative Complications of Anterior Cervical Surgery?

“… 5) Furthermore, since surgery for MSC is often extensive for patients who are prone to complications, the significance of selecting a surgical strategy should be further emphasized. 4) Moreover, if RT performed preoperatively as an initial treatment modality for MSC increases the complication rates of ACSS, surgeons should consider performing the posterior approach instead for patients who underwent preoperative RT. A posterior approach of the cervical spine is rather a simple procedure than an anterior approach, which requires fascial plane dissection between vital structures.…”

“… 1 2 3) Although surgery could provide instant stability and effective cord decompression, it is accompanied by risk for patients prone to complications due to multiple comorbidities. 4) Therefore, RT is often chosen as an initial management for MSC because it does not cause surgical damage to patients. 2 3 5) However, when symptoms or instability progresses, despite previous RT, surgery is required again.…”

“… 2 3 5) However, when symptoms or instability progresses, despite previous RT, surgery is required again. 4) …”

The value of histopathology combined with CapitalBio Mycobacterium real-time polymerase chain reaction test for diagnosing spinal tuberculosis

“…Diseases in the spine decrease the Yao et al 10.3389/fmed. 2023.1173368 Frontiers in Medicine 02 frontiersin.org system's stability and affect motor and neurological function (5).…”