Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, China.
Department of Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100032, China.
J Orthop Surg Res. 2024 Nov 20;19(1):774. doi: 10.1186/s13018-024-05266-x.
This study aimed to evaluate the neurological outcomes of Metastatic epidural spinal cord compression (MESCC) patients who underwent decompressive surgery after experiencing over 48 h of paralysis.
This retrospective study hypothesizes that, unlike in cases of trauma and degenerative disorders where delayed decompression surgery often leads to poor outcomes, delayed decompression surgery for MESCC-induced paralysis yields relatively favorable results. This study included MESCC patients who had been paralyzed for more than 48 h and underwent decompressive surgery between January 2012 and December 2020. Data collected mainly included patient demographics, tumor pathologies, neurological function (Frankel grades), ambulatory status, and imaging manifestions. The primary outcome measure was neurological recovery.
A total of 37 patients were included, with a median preoperative paralysis duration of 9 days. Following decompressive surgery, 30 patients (81.1%) improved by at least one Frankel grade. Specifically, 22 patients (59.5%) regained ambulatory ability. The percentages of patients with Frankel grades A, B, and C who regained ambulation after surgery were 28.6% (2 out of 7), 57.1% (8 out of 14), and 75.0% (12 out of 16), respectively.
Decompressive surgery is associated with significant neurological recovery in MESCC patients who have been non-ambulatory for more than 48 h. Surgical intervention remains beneficial even in cases of prolonged paralysis.
本研究旨在评估经历超过 48 小时瘫痪后接受减压手术的转移性硬膜外脊髓压迫（MESCC）患者的神经结局。
本回顾性研究假设，与创伤和退行性疾病不同，在这些疾病中，延迟减压手术通常导致不良结果，MESCC 引起的瘫痪延迟减压手术产生相对较好的结果。本研究纳入了自 2012 年 1 月至 2020 年 12 月期间经历超过 48 小时瘫痪并接受减压手术的 MESCC 患者。收集的数据主要包括患者人口统计学、肿瘤病理学、神经功能（Frankel 分级）、活动能力和影像学表现。主要结果测量是神经恢复情况。
共纳入 37 例患者，术前瘫痪中位时间为 9 天。减压手术后，30 例患者（81.1%）至少提高了一个 Frankel 分级。具体来说，22 例患者（59.5%）恢复了活动能力。手术后 Frankel 分级 A、B 和 C 的患者恢复活动能力的比例分别为 28.6%（7 例中有 2 例）、57.1%（14 例中有 8 例）和 75.0%（16 例中有 12 例）。
在经历超过 48 小时非活动状态的 MESCC 患者中，减压手术与显著的神经恢复相关。即使在瘫痪时间延长的情况下，手术干预仍然有益。
