Therapeutic Opportunity Window for Surgical Management in Patients With Malignant Spinal Compression: Systematic Review And Meta-Analysis.

Study design: Systematic review and meta-analysis.

Objective: To determine the optimal time to perform surgery in patients with malignant cord compression.

Summary of background data: Malignant cord compression (MSC) is a frequent complication of spinal metastases, being reported in about 5%-10% of all cancer patients. The sequelae caused by spinal cord compression can be devastating, causing disability, deterioration of their quality of life, and even death. Patients with malignant cord compression frequently require surgical management to preserve neurological function.

Methods: This systematic review identified studies that tested different therapeutic windows for surgical decompression. The articles that met the inclusion criteria were meta-analyzed to compare the patients with early versus late decompression after the onset of neurological symptoms. The result of interest was the recovery of walking ability.

Results: Out of the 1003 abstracts reviewed, 5 studies (389 patients) met the inclusion criteria. All 5 were retrospective studies that proposed surgical intervention in the first 48 hours after the onset of neurological symptoms as the necessary therapeutic window. When comparing early versus late intervention, surgery before the first 48 hours had an odds ratio of 3.92 [95% CI: 1.51-10.18] for recovering walking ability.

Conclusion: Surgery in the first 48 hours after the onset of neurological symptoms in patients with malignant cord compression is associated with a greater chance of recovery of walking ability. Since the literature is scarce, studies with more evidence are needed on this topic.