Introduction: Symptomatic acute metastatic spinal epidural cord compression (MSCC) is an emergency that requires multimodal attention. However, there is no clear consensus on the appropriate timing for surgery. Therefore, to address this issue, we conducted a systematic review and meta-analysis of the literature to evaluate the outcomes of different surgery timings. Methods: We searched multiple databases for studies involving adult patients suffering from symptomatic MSCC who underwent decompression with or without fixation. We analyzed the data by stratifying them based on timing as emergent (≤24 h vs. >24 h) and urgent (≤48 h vs. >48 h). The analysis also considered adverse postoperative medical and surgical events. The rates of improved outcomes and adverse events were pooled through a random-effects meta-analysis. Results: We analyzed seven studies involving 538 patients and discovered that 83.0% (95% CI 59.0-98.2%) of those who underwent urgent decompression showed an improvement of ≥1 point in strength scores. Adverse events were reported in 21% (95% CI 1.8-51.4%) of cases. Patients who underwent emergent surgery had a 41.3% (95% CI 20.4-63.3%) improvement rate but a complication rate of 25.5% (95% CI 15.9-36.3%). Patients who underwent surgery after 48 h showed 36.8% (95% CI 12.2-65.4%) and 28.6% (95% CI 19.5-38.8%) complication rates, respectively. Conclusion: Our study highlights that a 48 h window may be the safest and most beneficial for patients presenting with acute MSCC and a life expectancy of over three months.

BACKGROUND: Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence.
METHODS: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications.
RESULTS: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up.
CONCLUSIONS: Surgical treatment of spinal metastatic disease improves patients\' quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.

BACKGROUND: Surgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data on whether SD is beneficial are scarce. This study aims to investigate the neurological outcome of patients without neurological deficit, with a low- to intermediate-ESCC, who were treated with or without SD.
METHODS: This single-center, multidepartment retrospective analysis includes patients treated for spinal epidural metastases from 2011 to 2021. Neurological status was assessed by Frankel grade, and intraspinal tumor burden was categorized according to the ESCC scale. Spinal instrumentation surgery was only considered as SD if targeted decompression was performed.
RESULTS: ESCC scale was determined in 519 patients. Of these, 190 (36.6%) presented with no neurological deficit and a low- to intermediate-grade ESCC (1b, 1c, or 2). Of these, 147 (77.4% were treated with decompression and 43 (22.65%) without. At last follow-up, there was no difference in neurological outcome between the two groups.
CONCLUSIONS: Indication for decompressive surgery in neurologically intact patients with low-grade ESCC needs to be set cautiously. So far, it is unclear which patients benefit from additional decompressive surgery, warranting further prospective, randomized trials for this significant cohort of patients.

UNASSIGNED: Our study is to determine the correlation between preoperative MRI parameters of spinal cord compression and the effects of anterior surgery in patients with degenerative cervical myelopathy (DCM).
UNASSIGNED: 24 normal subjects with no evident abnormalities were selected as group A. 79 patients with DCM underwent single-segment (C4-5/C5-6) ACDF surgery formed the operation group, and separated into group B (without high signal) and group C (with high signal) according to the absence or presence of high signal in the spinal cord on preoperative T2-weighted MRI respectively. MRI parameters (MCC, maximum canal compromise; MSCC, maximum spinal cord compression; CR, spinal cord compression rate; RCSCDS, ratio of cervical spinal cord to dura sac) were measured. The JOA score was used to evaluate cervical spinal cord function and recovery rate (RR) was used to evaluate postoperative efficacy. The relationship between preoperative MRI parameters and postoperative efficacy was analyzed.
UNASSIGNED: The preoperative JOA score and RR of group B were higher than that of group C. MCC and MSCC in group B were significantly lower than those in groups C. The multiple linear regression equation was the fitted postoperative JOA score = 13.371-2.940 * MCC -5.660 * RCSCDS +0.471 * preoperative JOA score. The fitted RR = 1.451-0.472 * MCC -1.313 * RCSCDS.
UNASSIGNED: The occurrence of high signal on T2-weighted images could reflect more serious spinal cord injury. The postoperative JOA score was significantly correlated with MCC, RCSCDS, and preoperative JOA score, while RR was significantly associated with MCC and RCSCDS.

We performed a retrospective observational study to analyze the neurological recovery pattern in patients with a sub-laminar retro-thecal epidural abscess managed at our tertiary apex center from 2014 to 2020. We evaluated the Maximal Spinal Cord Compression (MSCC) ratio on Magnetic Resonance Imaging (MRI), the time interval between the appearance of neurological deficit and the initiation of management, spasticity as per Modified Ashworth Scale, presence of drug resistance, and the Lower Extremity Motor Score (LEMS). All patients were given anti-tubercular chemotherapy. We surgically managed 8 patients of which 6 required decompression alone, while 2 patients required additional instrumentation. 2 patients were managed conservatively of which 1 responded favorably to conservative treatment while the other patient showed a worsening of neurology following the detection of drug resistance and abrupt discontinuation of chemotherapy. The mean LEMS on admission was 20.2, which improved to 38.5 at the end of 1 year (p-value <0.05). The patients in whom the time interval between the onset of neurological deficit and the initiation of management was fewer than 6 weeks showed better LEMS and milder or absent spasticity at follow-up (p-value <0.05). The MSCC ratio did not have a significant correlation with the LEMS (p-value >0.05).

Prostate-related metastatic spinal cord compression (MSCC) accounts for 50% of all MSCC cases and constitute an oncological emergency. Metastatic spread has a detrimental impact on patient quality of life and the whole management strategy. We sought to identify the prognostic factors influencing the survival rate of patients operated for prostate-related MSCC. Sixty medical records of patients operated for prostate-related MSCC were selected from January 2002 to December 2014 in the Neurosurgery Department, Yopougon Teaching Hospital, Abidjan, Ivory Coast. Tokuhashi and Karnofsky scales were used to assess prognostic scores. Survival curves were generated using the Kaplan-Meier, and we used the log rank analysis for statistical comparison with a statistical significance threshold p < 0.05. The mean age was 57.16 ± 9.3 years (41-80) with an average of 57 years. The mean survival of the population was 27 ± 5 months (1-55 months), and the overall survival curve showed that 50% survival rate was seen in 31 months. The following parameters were associated with a poor overall survival rate: Tokuhashi score between 0 and 8 and Karnofsky score ≤ 50%. Poor overall survival rate was also observed in patient over 60 years of age, WHO score > 3, Frankel scale A-B, presence of metastasis, Gleason score > 5, PSA levels > 100 ng/ml, LH-RH analogue (decapeptyl LP 11.25) and anterior corpectomy and fusion. All analysis failed to show any significant difference. The management of prostate-related MSCC requires a multidisciplinary approach. Surgery has an unequivocal impact on patient quality of life if their combined prognostic scores are satisfactory.

UNASSIGNED: A retrospective multivariate analysis.
UNASSIGNED: To analyze clinical outcomes of surgical treatment and prognostic factors of local failure after stereotactic body radiation therapy (SBRT) in patients with spinal metastatic non-small-cell lung cancer (NSCLC).
UNASSIGNED: This study included patients with metastatic spinal cord compression (MSCC) from spinal NSCLC after radiotherapy who received massive spondylectomy for circumferential decompression of spinal cord and reconstruction of spinal stability in our center between May 2006 and February 2017. Neurological function was evaluated using the Frankel score. Overall survival (OS) was estimated by the Kaplan-Meier method. Factors with Pvalues ≤.1 were subjected to multivariate analysis for OS by proportional hazard analysis. Values of P<.05 were considered statistically significant.
UNASSIGNED: The mean age of the 55 included patients (36 male and 19 female) was 57.76 ± 8.94 (median 58, range 36-77) years, with a mean postoperative OS of 14.98 ± 14.81 (median 10.0, range 1-84) months. Neurological function was improved in 46 (83.6%) of the 55 patients after surgery. Prognostic analysis suggested that preoperative frankel score (FS) score, visceral metastasis, D-dimer (D-D) level, and neutrophil/lymphocyte ratio (NLR) were independent prognostic factors for selected patients.
UNASSIGNED: Massive spondylectomy could provide circumferential decompression and improve the neurological function of patients with MSCC from spinal NSCLC after radiotherapy. A preoperative FS score of C/D, no visceral metastasis, D-D <1000 μg/L, and NLR <5 are predictors of better prognosis.

The purpose of this study is to explore experiences in the days and weeks following discharge home following diagnosis and treatment for metastatic spinal cord compression (MSCC).
Eleven participants took part in audio-recorded semi-structured interviews about their experiences at 1 and 3-4 weeks post-discharge home following a diagnosis of MSCC. Transcripts were analysed using a framework approach.
Time emerged as an overarching theme within the framework of four time points: past, present, near future and distant future. Themes included getting home, challenges at home, community support, getting back to normal, in limbo, long-term goals and coping strategies.
Getting to a level of coping at home after discharge following MSCC can take time. Services need to address this so that patients can live well within the limitations they face.

BACKGROUND: The surgical treatment in spinal metastases has been shown to improve function and neurologic outcome. Unplanned hospital readmissions can be costly and cause unnecessary harm.
OBJECTIVE: Our aim was to first analyze the reoperation rate and indications for this revision surgery in spinal metastases from an academic tertiary spinal institute and, second, to make comparisons on outcome (neurology and survival) against patients who underwent single surgery only.
METHODS: This was an ambispective review of all patients treated surgically over an 8-year period considering their neurologic and survival outcome data. Statistical analysis was performed using IBM SPSS 20. Because all scale values did not follow the normal distribution and significant outlier values existed, all descriptive statistics and comparisons were made using median values and the median test. Crosstabs and Pearson correlation were used to calculate differences between percentages and ordinal/nominal values. For two population proportions, the z test was used to calculate differences. The log-rank Mantel-Cox analysis was used to compare survival.
METHODS: During the 8 years\' study period, there were 384 patients who underwent urgent surgery for spinal metastasis. Of these, 289 patients were included who had sufficient information available. There were 31 reoperations performed (10.7%; mean age, 60 years; 13 male, 18 female). Exclusion criteria included patients treated solely by radiotherapy, patients who had undergone surgery for spinal metastasis before the study period, and those who had other causes for neurologic dysfunction such as stroke.
METHODS: The outcomes considered in this study were revised Tokuhashi score, preoperative/postoperative Frankel scores, and survival.
METHODS: We performed an ambispective review of all patients treated surgically from our comprehensive database during the study period (October 2004 to October 2012). We reviewed all patient records on the database, including patient demographics and reoperation rates.
RESULTS: Reoperations were performed in the same admission in the majority of patients (n=20), whereas 11 patients had their second procedure in subsequent hospitalization. The reasons for their revision surgery were as follows: surgical site infection (SSI; 13 of 31 [42%]), failure of instrumentation (9 of 31 [29%]), local recurrence (5 of 31 [16%]), hematoma evacuation (2 of 31 [6%]), and others (2 of 31 [6%]).When comparing the \"single surgery\" and \"revision surgery\" groups, we found that the median preoperative and postoperative Frankel scores were similar at Grade 4 (range, 1-5) for both groups (preoperative, p=.92; postoperative, p=.87). However, 20 patients (8%) from the single surgery group and 7 (23%) from the revision group had a worse postoperative score, and this was significantly different (p=.01). No significant difference was found (p=.66) in the revised Tokuhashi score. The median number of survival days was similar (p=.719)-single surgery group: 250 days (range, 5-2,597 days) and revision group: 215 days (range, 9-1,352 days).
CONCLUSIONS: There was a modest reoperation rate (10.7%) in our patients treated surgically for spinal metastases over an 8-year period. Most of these were for SSI (42%), failure of instrumentation (26%), and local recurrence (16%). Patients with metastatic disease could benefit from revision surgery with comparable median survival rates but relatively poorer neurologic outcomes. This study may help to assist with informed decision making for this vulnerable patient group.

OBJECTIVE: To audit the current use of radiotherapy in UK cancer centres for the treatment of metastatic spinal cord compression against national standards that seek to optimise functional and quality of life outcomes.
METHODS: A Royal College of Radiologists prospective national audit of patients treated with radiotherapy in UK cancer centres was carried out over a 3 month period between September and December 2008, with a repeat audit carried out in August 2012.
RESULTS: Five hundred and ninety-six cases were received from 42 cancer centres (74%) in 2008, with data from 323 cases received from 52 (90%) centres in 2012. Ninety-three per cent (358) of patients had a diagnostic magnetic resonance imaging scan carried out within 24 h of referral for radiotherapy in 2008 compared with 205 patients (97%) in 2012. One hundred and eleven (32%) good prognosis patients were discussed with spinal surgeons; only 10 good prognosis patients were recorded as proceeding to surgery in 2008. This improved in 2012, with 94 (41% of good prognosis patients recorded as having been discussed with nine proceeding to surgery). Sixty-nine per cent of paraplegic patients in 2008 received multiple fractions of radiotherapy, which was similar to 2012 when 62% received more than a single fraction. A metastatic spinal cord compression co-ordinator was available in just over 50% of cases (164/323) and was involved in patient management in 26% of cases in 2012.
CONCLUSIONS: Despite level 1 evidence of the superior functional outcome and survival benefit for surgery, few good prognosis patients were recorded as having been discussed with surgeons and even fewer proceeded to surgery.