Study Design.

Systematic literature review and expert survey

Objective.

The aim of this study was to determine factors associated with neurologic improvement in patients with neurologic deficits secondary to metastatic epidural spinal cord compression (MESCC). Clear understanding of these factors will guide surgical decision-making by helping to elucidate which patients are more likely to benefit from surgery and how surgeons can increase the probability of neurologic and functional restoration.

Summary of Background Data.

Surgical spinal cord decompression has been shown to improve neurologic function in patients with symptomatic MESCC. However, prognostication of neurologic improvement after surgery remains challenging, owing to sparse data and complexity of these patients.

Methods.

PubMed and Embase databases were searched for relevant publications. PRISMA Statement guided publication selection and data reporting. GRADE guidelines were used for evidence quality evaluation and recommendation formulation.

Results.

Low-quality evidence supports the use of the duration and severity of neurologic deficit as predictors of neurological recovery in patients with MESCC. Low-quality evidence supports the use of thoracic level of compression and previous irradiation as adverse predictors of neurological recovery. Nearly all of the AOSpine Knowledge Forum Tumor members who responded to the survey agreed that ambulation with assistance represented a successful surgical result and that duration of ambulation loss and the severity of weakness should be considered when trying to predict whether surgery would result in restoration of ambulation.

Conclusions.

Review of literature and expert opinion support the importance of duration of ambulation loss and the severity of neurologic deficit (muscle strength, bladder function) in prediction of neurologic recovery among patients with symptomatic MESCC. Efforts to reduce the duration of ambulation loss and to prevent progression of neurologic deficits should be made to improve the probability of neurologic recovery.

Level of Evidence: 2

Spinal surgery remains an integral treatment component in the continuously shifting landscape of managing patients with metastatic cancer. 1–4 The goals of surgery in patients with metastatic epidural spinal cord compression (MESCC) include restoration and preservation of neurologic function, and spinal stability and pain relief. The functional status of cancer patients correlates with quality of life and survival, with ambulatory patients surviving longer than patients who have lost the ability to ambulate. 3, 5 Ambulation also serves as a requisite for further systemic therapy and inclusion in clinical trials, further supporting the significance of neurologic preservation and restoration.