Outcome of surgical treatment for MESCC (metastatic epidural spinal cord compression) in 175 patients: A single-center retrospective study
Mirza Pojskic (Marburg), Miriam Bopp (Marburg), Sebastian Wilke (Marburg), Christopher Nimsky (Marburg), Benjamin Saß (Marburg)
The aims of this single-center retrospective study were to assess the surgical results and survival of surgically treated patients affected by metastatic epidural spinal cord compression (MESCC) and identify any factors related to favorable outcome and better survival rate.
All patients who underwent surgery for spine metastases at our Department in period 2018-2022 were included in the study. Patient data were evaluated retrospectively.
175 patients (71 female, median age 67.15, age range 29-90 years) were included in the study. Most common primary tumor was lung carcinoma (n=31), prostate (n=31), breast carcinoma (n=28), multiple myeloma (n=25), clear cell renal carcinoma (n=11) and rest (n=49). In 56 patients spinal metastasis was the initial symptom which led to diagnosis of the primary tumor. ECOG-performace status was 0 in 7 patients, 1 in 97, 2 in 27, 3 in 17 and 4 in 27. Average time from beginning of symptoms to diagnosis was 75 days. In 24 cases tumor was located in cervical spine, in 89 in thoracic, in 37 in lumbar and in rest in two regions of the spine at the same time. In 108 patients pathological fracture was present. In 42 patients only decompression was performed, in 133 additional instrumentation surgery, 23 patients underwent vertebral body replacement with implant. Most common complications were wound healing deficits (n=14, 8%) and hardware failure (n=14, 8%). 89 patients (50.85%) had motor deficits prior to surgery. In terms of pain and neurological deficits, 122 patients improved, 43 were unchanged and 10 deteriorated. Average readmission free survival was 283.74 days and average overall survival was 425.23 days. Tomita score<7, Frankel score A-C, ECOG 0-1, modified Tokuhashi score>10, were found to be significant favorable prognostic factors (p<0.01).
The majority of patients, undergoing decompression and/or stabilization for metastatic spinal tumors, have profited from surgical therapy in terms of pain and reversal of neurological deficits and overall survival.
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