Assessing Predictors of Neurologic Improvement and Readmissions Following Urgent Cord Decompression Due to Neoplastic Causes

Introduction: Urgent cord decompression is a critical intervention for patients suffering from neoplastic spinal cord compression, aiming to extenuate neurological deficits, discomfort, and prevent permanent disability. This study aims to contribute to a more comprehensive understanding of post-surgical recovery trajectories in this high-risk population. By doing so, it seeks to inform targeted interventions that can reduce readmission rates and improve the quality of life for patients with neoplastic spinal cord compression.

Methods: Patients were queried for cord compression due to neoplastic causes from the electronic medical health record. Patients with decompressive surgery within 21 days of cord compression diagnosis were included. Age, sex, comorbidities, neoplasm history, surgery characteristics, and complications were collected. The outcome of interest included neurologic improvement after surgery, time-to-improvement, and 90-day readmission rates including direct hospital admission or emergency department admission. Variables of interest were assessed with univariate analysis.

Results: 28 patients fit inclusion criteria. Of these, 15 (53.6%) were male, the average age was 60.2 (SD: 12.3) years. Mean Charlson Comorbidity Index Scores (CCI) were 2 (IQR: 5.5). Average time to decompression was 6.13 days, the median number of levels decompressed was 1 (IQR: 1), 11 (45.8%) of patients had 1 metastasis, 6 (25%) had 2, and 7 (29.2%) had 3 or more. 16 (57.1%) of patients had a readmission or ED visit within 90 days of their surgery. Univariate analysis highlighted time-to-decompression (OR: 0.74 95% CI: 0.53-0.93) to be associated with neurologic improvement and time-to-neurologic improvement (p = 0.006). No covariates were found to be associated with readmission. Of note, 4 patients had a time-to-decompression >10 days, of these, half achieved neurologic improvement.

Conclusion : In neoplastic cord compression, time to decompression was predictive of neurologic improvement and the time to reach neurologic improvement. Patients with longer delays may still experience neurologic improvement. Larger cohort studies are needed to explore additional predictors for neurologic outcomes and readmission in this population.