Treatment and outcomes of patients with metastatic spinal cord compression: a double-center study

Abstract

OBJECTIVE: Spinal metastases may only affect the bone tissue and result in spi-nal instability or may additionally result in epi-dural compression, leading to neurological defi-cits. Surgery has emerged as a popular method in treating metastatic epidural spinal cord com-pression (MESCC) due to the advances in surgical techniques and instrumentation. In this study, we evaluated patients with MESCC regarding neuro-logical status, pain status, and survival rates, and presented our experience managing MESCC.PATIENTS AND METHODS: Clinical and ra-diographic records of 53 patients diagnosed with MESCC between January 2011 and March 2017 were retrospectively evaluated. The study included patients with a pathological diagnosis of primary cancer, those who complained of spi-nal metastasis, and those who had indications of MESCC on Magnetic Resonance Imaging (MRI). Bone structure and spinal stability were evaluat-ed using assessed Computed Tomography (CT), and metastatic spread was considered using as-sessed Positron Emission Tomography (PET) in suitable cases. For each patient, the presence of a tumor compressing the spinal cord, age, gen-der, preoperative, and postoperative American Spinal Injury Association scores (ASIA), Toku-hashi prognostic score (TPS), affected spinal segment, pathological diagnosis, preoperative, and postoperative Visual Analog Scale (VAS), the status of spinal stability, follow-up period, and complications were evaluated.RESULTS: Forty-five patients (82.2% of them were women) underwent surgery with a mean age of 58.29 & PLUSMN; 15.14 years. The most frequent type of primary tumor was multiple myeloma (33.9%), followed by lung (24.6%), gastric (7.5%), and prostate (5.7%). The most common site of metastasis was the thoracic region (43.4%), fol-lowed by lumbar (24.5%), multiple (24.5%), and cervical (5.7%). The analysis indicated that a sig-nificant difference was found between the sur-vival rates of the TPS categories.CONCLUSIONS: Common symptoms of MES-CC include spinal pain and neurological defi-cit below the level of the injury. Prompt surgi-cal treatment followed by oncological treatment leads to significant neurological recovery, more prolonged survival, pain relief, and improved quality of life in patients with a short survival time. Oncological treatments, including radio-therapy (RT), should be recommended after sur-gical treatment.