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Media type:
E-Article
Title:
Spinal oncologic paraparesis: Analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors
Contributor:
Alhalabi, Obada T.;
Heene, Stefan;
Landré, Vincent;
Neumann, Jan-Oliver;
Scherer, Moritz;
Ishak, Basem;
Kiening, Karl;
Zweckberger, Klaus;
Unterberg, Andreas W.;
Younsi, Alexander
Description:
<jats:sec><jats:title>Objectives</jats:title><jats:p>Paraparesis due to oncologic lesions of the spine warrants swift neurosurgical intervention to prevent permanent disability and hence maintain independence of affected patients. Clinical parameters that predict a favorable outcome after surgical intervention could aid decision-making in emergency situations.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients who underwent surgical intervention for paraparesis (grade of muscle strength &lt;5 according to the British Medical Research Council grading system) secondary to spinal neoplasms between 2006 and 2020 were included in a single-center retrospective analysis. Pre- and postoperative clinical data were collected. The neurological status was assessed using the modified McCormick Disability Scale (mMcC) Score. In a univariate analysis, patients with favorable (discharge mMcC improved or stable at &lt;3) and non-favorable outcome (discharge mMcC deteriorated or stable at &gt;2) and different tumor anatomical compartments were statistically compared.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>117 patients with oncologic paraparesis pertaining to intramedullary lesions (n=17, 15%), intradural extramedullary (n=24, 21%) and extradural lesions (n=76, 65%) with a mean age of 65.3 ± 14.6 years were included in the analysis. Thoracic tumors were the most common (77%), followed by lumbar and cervical tumors (13% and 12%, respectively). Surgery was performed within a mean of 36±60 hours of admission across all tumors and included decompression over a median of 2 segments (IQR:1-3) and mostly subtotal tumor resection (n=83, 71%). Surgical and medical complications were documented in 9% (n=11) and 7% (n=8) of cases, respectively. The median hospital length-of-stay was 9 (7-13) days. Upon discharge, the median mMcC score had improved from 3 to 2 (p&lt;0.0001). At last follow-up (median 180; IQR 51-1080 days), patients showed an improvement in their mean Karnofsky Performance Score (KPS) from 51.7±18.8% to 65.3±20.4% (p&lt;0.001). Localization in the intramedullary compartment, a high preoperative mMcC score, in addition to bladder and bowel dysfunction were associated with a non-favorable outcome (p&lt;0.001).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The data presented on patients with spinal oncologic paraparesis provide a risk-benefit narrative that favors surgical intervention across all etiologies. At the same time, they outline clinical factors that confer a less-favorable outcome like intramedullary tumor localization, a high McCormick score and/or bladder and bowel abnormalities at admission.</jats:p></jats:sec>