Effect of preoperative neurological dysfunction duration on short-term postoperative neurological recovery in patients with spinal metastases

English Keywords:Spinal metastases  Surgery  Postoperative short-term  Clinical outcome

English Abstract:

  【Abstract】 Objectives: To analyze the influence of preoperative neurological dysfunction time on postoperative short-term neurological function recovery. Methods: A retrospective analysis was performed on 120 patients with spinal metastases who received surgical treatment from January 2021 to December 2023. There were 68 males and 52 females, aged 58.5±11.6 years(27-82 years). The main clinical symptoms were pain in the affected segment and neurological function impairment. The primary tumors were lung cancer(38 cases), kidney cancer(21 cases), breast cancer(13 cases), myeloma(15 cases), lymphoma(5 cases), and other sources of tumor(28 cases). The procedures used included percutaneous vertebroplasty(PVP) (5 cases), total en-bloc spondylectomy(TES) (14 cases), spinal tumor separation surgery(67 cases), and focal palliative excision decompression surgery(34 cases). Numerical rating scale(NRS) and American Spinal Injury Association(ASIA) spinal cord injury scale were used to evaluate the pain grade and nerve function of patients before surgery and on the 5th day after surgery, respectively. The degree of spinal cord compression was evaluated using the epidural spinal cord compression(ESCC) scoring system. The time period from muscle strength impairment below the affected plane to surgery for patients with ASIA AB and C was recorded as the time of preoperative neurological dysfunction. For patients with ASIA AB before surgery, three time points of 7d, 10d and 15d were selected. For patients with ASIA grade C before surgery, two time points were selected: 15d and 30d. The postoperative neurological improvement rate(the proportion of patients with at least one grade improvement of ASIA classification after surgery) of the two groups at different time points were calculated and analyzed. Results: Spinal stability was restored after surgery, and adequate decompression was performed to relieve nerve compression(except PVP). Postoperative NRS scores were significantly lower in all the patients[preoperative 6.00(2.00) vs postoperative 3.00(1.00), P=0.000]. The neurological function of some patients was improved immediately after operation, and the ASIA grade improved at least one grade in 17 patients(74%) of preoperative grades AB, 10 patients(63%) of preoperative grade C, and 18 patients(47%) of preoperative grade D. There was no difference in ESCC scores between patients with preoperative grade C and those with preoperative grades A and B[3.00(1.00) vs 3.00(0.00), P=0.070]. For patients with preoperative ASIA grades AB, the improvement rate of short-term postoperative neurological function in patients with preoperative neurological dysfunction ≤10d was significantly better than that in patients with >10d(>10d 57.1% vs ≤10d 100%, P=0.048). For patients with preoperative ASIA grade C, the improvement rate of short-term postoperative neurological function in patients with preoperative neurological dysfunction ≤30d was significantly better than that in patients with >30d(>30d 20.0% vs ≤30d 81.8%, P=0.036). Conclusions: Patients with spinal metastases can get pain relief in the short-term after surgery. The time of neurological dysfunction before surgery has a significant effect on the short-term recovery of neurological function after surgery.