gms | German Medical Science

Objective: Publications on treatment of spinal tumors tend to concentrate on resection results and short-term clinical outcomes. We are lacking statistical data on permanent surgical morbidity (PSM) for patient counseling and selecting the right time for surgery.

Methods: All patients operated for spinal tumors were continuously incorporated into a register for spinal cord pathologies since 1991. For this analysis, PSM rates were calculated for 1406 operations included until 2017 (274 intramedullary, 631 extramedullary and 501 extradural tumors, respectively). PSM was defined as permanent neurological worsening within 30 days of surgery without long-term recovery. Multiple regression analyses were performed to define factors predisposing or reducing morbidity rates. Odds ratios were calculated for independent risk factors and patient populations defined with particularly low or high morbidity risks, respectively.

Results: For extradural tumors a PSM rate of 7.2% was observed (soft-tissue tumors 6.6%, bone tumors 7.5%). For bone tumors, an ASA-score higher than 3 and involvement of multiple vertebrae increased PSM by a factor of 3.1 and 2.6, respectively. In combination, the PSM rate increased to 23.8% in this subgroup. For extramedullary tumors the PSM rate was determined as 7.1%. The risk factor with by far highest predictive power was surgery on a recurrent tumor (odds ratio 4.6; PSM 4.6% first surgery, 18.0% recurrent tumors). Intramedullary tumors were associated with the highest PSM rate of all spinal tumors (18.3%). Independent risk factors for PSM increasing odds by a factor of about 2 were severe gait problems before surgery, high McCormick grade, thoracic level, long history and surgery by a less experienced surgeon. The subgroup of patients with impaired walking ability due to a thoracic tumor showed a PSM rate of 30.8%, surgery by an experienced surgeon in a patient still able to walk without aid reduced PSM to 9.4%.

Conclusion: In summary, early diagnosis and treatment reduces permanent surgical morbidity for all spinal tumors. Surgery on extensive bone tumors, recurrent extramedullary tumors and thoracic intramedullary tumors carry the highest risks for PSM. In order to minimize PSM for treatment of intramedullary tumors the recommendation for early surgery by a surgeon experienced in their management cannot be overemphasized.