Spinal oncologic paraparesis: Analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors

被引:5
作者
Alhalabi, Obada T. [1 ]
Heene, Stefan [1 ]
Landre, Vincent [1 ]
Neumann, Jan-Oliver [1 ]
Scherer, Moritz [1 ]
Ishak, Basem [1 ]
Kiening, Karl [1 ]
Zweckberger, Klaus [2 ]
Unterberg, Andreas W. [1 ]
Younsi, Alexander [1 ]
机构
[1] Heidelberg Univ Hosp, Dept Neurosurg, Heidelberg, Germany
[2] City Hosp Brunswick, Dept Neurosurg, Braunschweig, Germany
关键词
paraparesis; spinal metastases; spinal ependymomas; intramedullary tumors; McCormick score; QUALITY-OF-LIFE; CORD COMPRESSION; SURGERY; METASTASES; MENINGIOMAS; RESECTION; CANCER;
D O I
10.3389/fonc.2022.1003084
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
ObjectivesParaparesis 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. MethodsPatients who underwent surgical intervention for paraparesis (grade of muscle strength <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 <3) and non-favorable outcome (discharge mMcC deteriorated or stable at >2) and different tumor anatomical compartments were statistically compared. Results117 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<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<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<0.001). ConclusionThe 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.
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页数:15
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