Predictors of neurological recovery after surgery of metastatic epidural spinal cord compression

Objective: The aim of this study was to identify potential preoperative predictors (inclusive time between onset of motor weakness and surgical decompression) of neurological function and ambulation in a consecutive series of patients with MESCC treated with urgent spinal cord decompression. Material/Methods: 327 patients with MESCC who underwent emergency laminectomy were reviewed retrospectively. Variables evaluated were: age, gender, site of primary tumor, location of spinal cord compression, location and number of affected segments, time between onset of neurological deficits to surgical decompression, the preand early postoperative ASIA scores, preand postoperative ability to walk and to ambulate and the preand postoperative quality of walking. Variables were analyzed with uniand multivariate methods. A backward stepwise binary logistic regression analysis was performed to determine the effect of the evaluated variables in a multivariate model. Results: The majority of the patients were assigned to ASIA impairment scale grade D. At admission 49.5 % of the patients could walk and 50.5% of the patients were not able to walk. The mean time between onset of neurological deficits and decompression was 114.72 hours +/173.41 (range 2 – 1800 hours). Univariate analyses identified preoperative ASIA impairment scale grades, the ability to walk preoperatively, tumor localization, age and duration of symptom (time interval between onset of motor weakness and surgical decompression) as predictors for neurological improvement and outcome. In a multivariate model time between onset of motor weakness and surgical decompression (p<0,05) and the ability to walk preoperatively (p<0.0001) were significant independent predictors for improvement of the ability to walk. Conclusion: Early surgical decompression is important for neurological recovery in patients with MESCC especially with rapid neurological deterioration. Correspondence to: Privatdozent Dr. Matthias Setzer, Neurosurgical Department, Neurocenter, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. Tel: +49 69 63015295, E-mail: [email protected]