EVALUATION OF SURGICAL TIMING IN PATIENTS WITH SPINE METASTASES AND ACUTE SEVERE NEUROLOGICAL DEFICIT

D. Aiudi¹ , A. Raggi¹ , F. Cappella¹, L.G.M. Di Somma¹ , M. Gladi¹ , A. Di Rienzo¹ , M. Dobran¹

¹ Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy

Correspondence to:

Journal of Orthopedics 2023 Jan-Apr; 15(1): 32-36
https://doi.org/10.69149/orthopedics/2023v15iss1_5_5

Received: 22 February 2023 Accepted: 28 March 2023

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Abstract

Spine metastases are one of the main causes of non-traumatic spinal cord injury (SCI). The acute onset of a neurological deficit in cancer patients with metastases makes it necessary to perform a rapid decompression of the vertebral canal, generally within 48 hours of the onset, to improve the clinical and neurological outcome, avoiding the onset of edema, venous congestion and secondary vascular damage. However, the optimal timing for performing this procedure is a matter of debate in the literature. The aim of our study is to evaluate whether an early surgical intervention in patients with vertebral metastases debut with acute neurological deficit influences the clinical outcome. The study includes a series of 40 patients with vertebral metastases and acute onset of neurological deficit, who underwent decompressive laminectomy and vertebral arthrodesis from September 2013 to March 2021. For each patient has been collected information relating to age, sex, of admission to the emergency room and time of surgery, level of the lesion, pre- and post-operative neurological function evaluated with the Frankel scale and histology of the neoplastic lesion. In the population studied, the pre-operative Frankel value was distributed as follows: 17 grade A patients, 19 grade B patients and 4 grade C patients. As regards the surgical timing from the onset of the deficit, 15 patients were operated on in the first 12 hours, 9 patients between 12 and 24 hours, 2 patients between 24 and 48 hours, while 14 patients were operated after 48 hours. A statistically significant difference was found (p < 0.05) in terms of neurological outcome between those who were operated within 12 hours from symptom onset and patients operated subsequently. All subjects operated within 12 hours had a clinical improvement. On the basis of the collected and analyzed data, it is advantageous a surgically strategy within 12 hours from the onset of neurological symptoms in patients with vertebral metastases. In agreement with the literature, also in the series of this study, the early approach proved to be favorable. Therefore, it is reasonable to assume that an early management of the lesion allows to interrupt the cascade of events responsible for the secondary damage, with a consequent better residual medullary function.

Keywords: spinal tumors, surgical intervention, timing