Velocity of Patients’ Neurological Recovery After Surgical Decompression and Fixation of Spinal Metastatic Tumors

Introduction: We aim to identify time to neurologic recovery in patients undergoing resection and fixation of spinal column metastases.

Methods: We retrospectively analyzed time to neurological recovery and factors associated with ASIA improvement. Patients who underwent surgery over the past decade at our hospital were closely followed for 90 days postop. Inclusion criteria included patients with ASIA A-D preoperatively. Univariate analysis compared patients who improved ≥1 ASIA grade to those who did not. Multivariate analysis was performed to identify predictors of recovery.

Results: A total of 50 patients (22.4% female), mean age 58.6 years, with a mean SINS score of 9.5, were included. Sources of metastasis were renal (68.0%), hepatic (22.0%), and thyroid (10.0%). No differences in age, sex, BMI, or SINS category were observed between those who improved (n=26) and those who did not (n=24, including 5 who worsened). Baseline ASIA score distribution and bowel/bladder dysfunction were similar (p>0.05). The non-improved group had higher rates of baseline gait dysfunction (62.5% vs 34.6%,p=0.049). There were no differences in corpectomy rates (53.8% vs 41.7%) or levels operated. At discharge, the improved group had higher rates of ASIA E and lower rates of ASIA C (p < 0.05). 61.5% of the improved cohort did not improve until after discharge. By 90-days, those who did not improve had higher rates of sensory (66.7% vs 3.8%,p < 0.001) and gait deficits (66.7% vs 15.4%,p < 0.001). Multivariate analysis, adjusted for factors with p< 0.2, revealed preoperative gait dysfunction was significantly associated with lower odds of ASIA improvement at 90 days (OR:0.19, 95% CI:0.03-0.86,p=0.039).

Conclusion : In this cohort, 52.0% of patients improved ≥1 ASIA grade, and 48.0% did not improve. Preoperative gait dysfunction was associated with lower odds of ASIA improvement. While ASIA score by discharge is a good indicator for improvement, many patients who did not improve at discharge improved by 90 days (61.5%).