gms | German Medical Science

Objective: While it is known that surgical decompression of the spinal cord improves neurological outcomes in patients suffering from paraparesis or paraplegia from metastatic epidural spinal cord compression (MESCC), there is still controversy about the appropriate timing. To evaluate the impact of timing from symptom onset until surgical intervention, we performed a retrospective analysis of patients with MESCC treated with surgical decompression in our institution.

Methods: The medical records of 51 patients with a preoperative ASIA Score between A and D treated with a decompressive procedure included sufficient timing data and were retrospectively reviewed. Procedures performed included decompression, corpectomy as well as epidural resection, with or without instrumentation. We evaluated demographics, treatment modalities, time from symptom onset to surgery, amount of affected vertebrae as well as surgical time, blood loss, and perioperative complications. These parameters were analyzed for a correlation with neurological improvement.

Results: The mean age among the patient population was 62±14 years, including 32 males and 19 females. Twenty-nine patients presented with an ASIA score of D, 16 patients with C, four patients with B and two patients with A. The mean follow-up was 14±20 months. During the follow-up period, we observed neurological improvement in 23 patients. Nine patients (31%) improved from ASIA D to E, ten patients(63%) from C to D, one patient from C to E (6%), two patients from B to C (50%) and one patient from A to C. (50%) Among the patients with neurological improvement, six patients died after 25±28 months, while eight patients without postoperative improvement died after 7±8 months. When comparing all evaluated factors, only the time from symptom onset to surgery showed a significant correlation with neurological recovery (p<0.01). Patients who showed neurological improvement were operated within 6±8 days while patients without postoperative improvement were operated on average 16±33 days after symptom onset.

Conclusion: Apparently, the time from symptom onset to surgical decompression is a critical factor for neurological recovery in patients with paraparesis after MESCC. Interestingly, first neurologic symptoms are present many days prior to surgery, although development of severe paraparesis or paraplegia may then happen rapidly. Moreover, we observed a trend towards prolonged survival in patients who recovered after surgery.