Metastatic epidural spinal cord compression: does timing of surgery influence the chance of neurological recovery? An observational case-control study

  • Valerio Pipola
  • Silvia Terzi
  • Giuseppe Tedesco
  • Stefano Bandiera
  • Giovanni Barbanti Bròdano
  • Riccardo Ghermandi
  • Gisberto Evangelisti
  • Marco Girolami
  • Alessandro Gasbarrini
Original Article
  • 32 Downloads

Abstract

Purpose

Metastatic epidural spinal cord compression (MESCC) is radiologically defined as an epidural metastatic lesion causing the displacement of the spinal cord from its normal position in the vertebral canal. The purpose of this paper is the evaluation of the influence of timing of surgery on the chance of neurological recovery.

Methods

This is a retrospective observational case-control study performed on patients with MESCC from solid tumors surgically treated at our institute from January 2010 to December 2016. Patients included were divided in two groups depending on surgery that was performed within or after 24 h the admission to the hospital. Neurological status was assessed with American Spine Injury Association (ASIA) Impairment Scale.

Results

No statistically significant difference was observed in the variation of ASIA if surgery is performed within or after 24 h from the admission to the hospital. A statistically significant difference was observed after surgery in each group in the improvement of neurological status. A statistically significant difference was reported in the early post-operative complications in patients surgically treated within 24 h.

Conclusion

MESCC management is challenge for spine surgeons and may represent an oncologic emergency and if not promptly diagnosed can lead to a permanent neurological damage. According to this study, there is no difference in the chance of neurological recovery if surgery is performed within or after 24 h the admission to hospital, but there is a greater rate of early post-operative complications when surgery is performed within 24 h from the admission to the hospital.

Keywords

Spinal cord compression Metastatic epidural spinal cord compression MESCC ASIA score Chance of neurological recovery 

Notes

Acknowledgments

The authors acknowledge the invaluable contribution of Cristiana Griffoni and Carlo Piovani for patient storage and data collection.

Compliance with ethical standards

All patients were treated according to the ethical standards of the Helsinki Declaration and were invited to read, understand, and sign the informed consent form.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Valerio Pipola
    • 1
  • Silvia Terzi
    • 1
  • Giuseppe Tedesco
    • 1
  • Stefano Bandiera
    • 1
  • Giovanni Barbanti Bròdano
    • 1
  • Riccardo Ghermandi
    • 1
  • Gisberto Evangelisti
    • 1
  • Marco Girolami
    • 1
  • Alessandro Gasbarrini
    • 1
  1. 1.Department of Oncologic and Degenerative Spine SurgeryIRCCS Istituto Ortopedico RizzoliBolognaItaly

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