Spinal oncologic paraparesis

• Verfasst von: Alhalabi, Obada [VerfasserIn]
• Verfasst von: Heene, Stefan [VerfasserIn]
• Verfasst von: Landré, Vincent [VerfasserIn]
• Verfasst von: Neumann, Jan-Oliver [VerfasserIn]
• Verfasst von: Scherer, Moritz [VerfasserIn]
• Verfasst von: Ishak, Basem [VerfasserIn]
• Verfasst von: Kiening, Karl [VerfasserIn]
• Verfasst von: Zweckberger, Klaus [VerfasserIn]
• Verfasst von: Unterberg, Andreas [VerfasserIn]
• Verfasst von: Younsi, Alexander [VerfasserIn]
• Titel: Spinal oncologic paraparesis
• Titelzusatz: analysis of neurological and surgical outcomes in patients with intramedullary, extramedullary, and extradural tumors
• Verf.angabe: Obada T. Alhalabi, Stefan Heene, Vincent Landré, Jan-Oliver Neumann, Moritz Scherer, Basem Ishak, Karl Kiening, Klaus Zweckberger, Andreas W. Unterberg and Alexander Younsi
• E-Jahr: 2023
• Jahr: 04 January 2023
• Umfang: 15 S.
• Fussnoten: Gesehen am 16.01.2023
• Titel Quelle: Enthalten in: Frontiers in oncology
• Ort Quelle: Lausanne : Frontiers Media, 2011
• Jahr Quelle: 2023
• Band/Heft Quelle: 12(2023) vom: Jan., Artikel-ID 1003084, Seite 1-15
• ISSN Quelle: 2234-943X
• DOI: doi:10.3389/fonc.2022.1003084
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1831167921
• K10plus-PPN:
  Universitätsbibliothek
• Lokale URL UB: Zum Volltext

Abstract

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.