Evaluation of Preoperative Factors Associated with Early Postoperative Neurological Outcome in the Treatment of Metastatic Spinal Tumors.

Abstract

Purpose: To investigate the preoperative factors that affect early postoperative neurological outcome of metastatic spinal tumors in order to determine a new basis for surgical indication.

Methods: Eighty-seven patients with metastatic spinal tumors were included. Neurological status was assessed using the American Spinal Injury Association (ASIA) grade at 1 month postoperatively, with an additional evaluation at 3 months. Patients with preoperative ASIA grades B or C whose postoperative ASIA grade remained unchanged or worsened, and those with preoperative ASIA grades D or E whose postoperative grade worsened, were classified as having a poor neurological outcome. Patients whose postoperative ASIA grade improved were classified as the improved group. Preoperative clinical and radiological factors, including ASIA grade and spinal cord compression site, were analyzed using univariate and multivariate logistic regression analyses.

Results: Multivariate analysis identified preoperative ASIA grade B or C and circumferential spinal cord compression (anterior + posterior) as independent risk factors for poor neurological outcome at 1 month. In contrast, posterior-only spinal cord compression was an independent predictor of neurological improvement. Among patients with preoperative ASIA grades B or C, 11 of 12 patients with anterior + posterior compression experienced poor neurological outcomes, whereas 6 of 7 patients with posterior compression showed neurological improvement.

Conclusions: The spinal cord compression site was a neurological prognostic factor for early postoperative neurological outcome. Even in cases with an ASIA grade of B or C, neurological improvement in the early postoperative period was anticipated if the compression site was posterior-only.