The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale

Abstract Background context There have been no previous studies looking at the outcome of surgical decompression (+/−stabilization) for various grades of epidural spinal cord compression (ESCC) due to spinal metastases. Purpose The aim of this study was to determine the outcome of surgical treatment in patients with ESCC using the Bilsky six-point scale. Study design/Setting This was a retrospective cohort review of prospectively collected data. Patient sample A consecutive series of 101 patients managed over the period of 3 years for ESCC due to spinal metastases in a tertiary spine surgery referral unit were included. Methods Data on age, gender, revised Tokuhashi score, preoperative Frankel grade, tumor histology, magnetic resonance imaging scan–based Bilsky cord compression grade, postoperative Frankel grade at last follow-up, complications, and survivorship were collected. Outcome measures Frankel grading system for function was used to evaluate the patient's preoperative and postoperative neurologic status. Patient survival and postoperative complications were also collected. Results Average patient age was 64.7 years (13–88 years): 62 males and 39 females. Mean follow-up was 7.3 months (3–23.3 months). Most primary tumors were in prostate, breast, renal, lung, and the blood dyscrasias. Within the lower grade of compression (Group 1; Bilsky Grades 0,1a, 1b, and 1c; n=40), 29 patients (72.5%) had no improvement in Frankel grade, seven patients (17.5%) improved, whereas four patients (10%) deteriorated neurologically after surgery. Within the higher compression grade (Group 2; Bilsky Grades 2 and 3; n=61), 37 patients (60%) did not experience neurologic change, 20 (33%) improved, whereas neurology worsened in four patients (7%). When compared with Group 2 patients, Group 1 patients had better preoperative Frankel scores but a greater number of patients in Group 2 improved their Frankel scores significantly postoperatively. The mean revised Tokuhashi score for Groups 1 and 2 was 10 and 9.1, respectively (p=.1). The complication rate for Groups 1 and 2 was 25% and 42.6%, respectively (p=.052). Survival analysis showed no difference between the groups (Group 1: median 376 days [12–1052]; Group 2: median 326 days [12–979]; p=.62). Conclusions Surgery can achieve improvements in neurology even in higher grades of cord compression. There is a trend toward more complications and worse survival with spinal surgery in patients with higher grades of compression.