Alhalabi Obada T, Heene Stefan, Landré Vincent, Neumann Jan-Oliver, Scherer Moritz, Ishak Basem, Kiening Karl, Zweckberger Klaus, Unterberg Andreas W, Younsi Alexander
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Neurosurgery, City Hospital of Brunswick, Brunswick, Germany.
Front Oncol. 2023 Jan 4;12:1003084. doi: 10.3389/fonc.2022.1003084. eCollection 2022.
Paraparesis 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.
Patients 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.
117 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).
The 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.
因脊柱肿瘤性病变导致的双下肢轻瘫需要迅速进行神经外科干预，以防止永久性残疾，从而维持受影响患者的独立性。预测手术干预后良好结局的临床参数有助于在紧急情况下做出决策。
对2006年至2020年间因脊柱肿瘤继发双下肢轻瘫（根据英国医学研究委员会分级系统，肌力等级<5级）而接受手术干预的患者进行单中心回顾性分析。收集术前和术后的临床数据。使用改良的麦考密克残疾量表（mMcC）评分评估神经功能状态。在单因素分析中，对结局良好（出院时mMcC评分改善或稳定在<3分）和结局不佳（出院时mMcC评分恶化或稳定在>2分）的患者以及不同肿瘤解剖部位进行统计学比较。
117例因肿瘤导致双下肢轻瘫的患者纳入分析，其中髓内病变（n = 17，15%）、硬脊膜内髓外病变（n = 24，21%）和硬脊膜外病变（n = 76，65%），平均年龄为65.3±14.6岁。胸段肿瘤最为常见（77%），其次是腰段和颈段肿瘤（分别为13%和12%）。所有肿瘤患者平均在入院后36±60小时内接受手术，平均减压节段为2个（四分位间距：1 - 3），大多数患者进行了次全肿瘤切除（n = 83，71%）。手术并发症和医疗并发症的记录分别为9%（n = 11）和7%（n = 8）。中位住院时间为9（7 - 13）天。出院时，中位mMcC评分从3分改善至2分（p<0.0001）。在最后一次随访时（中位时间180天；四分位间距51 - 1080天），患者的平均卡氏功能状态评分（KPS）从51.7±18.8%提高至65.3±20.4%（p<0.001）。髓内病变部位、术前mMcC评分高以及膀胱和肠道功能障碍与不良结局相关（p<0.001）。
所呈现的脊柱肿瘤性双下肢轻瘫患者的数据提供了一个风险效益描述，支持对所有病因进行手术干预。同时，它们概述了一些导致结局较差的临床因素，如髓内肿瘤部位、高麦考密克评分和/或入院时膀胱和肠道异常。
