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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Decompressive surgery in patients with metastatic low to intermediate epidural spinal cord compression and no neurological deficit

Chirurgische Dekompression bei Patienten mit niedrig bis mittelgradiger epiduraler Rückenmarkskompression und ohne neurologisches Defizit

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Niklas von Spreckelsen - Universitätsklinikum Köln, Klinik für Neurochirurgie, Köln, Deutschland
  • Maximilian Lenz - Universitätsklinikum Köln, Unfallchirurgie-Orthopädie, Köln, Deutschland
  • Julian Ossmann - Universitätsklinikum Köln, Klinik für Neurochirurgie, Köln, Deutschland
  • Lukas Nadjiri - Universitätsklinikum Köln, Strahlentherapie, Köln, Deutschland
  • Moritz Lenschow - Universitätsklinikum Köln, Klinik für Neurochirurgie, Köln, Deutschland
  • Sergej Telentschak - Universitätsklinikum Köln, Klinik für Neurochirurgie, Köln, Deutschland
  • Kourosh Zarghooni - Universitätsklinikum Köln, Unfallchirurgie-Orthopädie, Köln, Deutschland
  • Johanna Meyer - Universitätsklinikum Köln, Unfallchirurgie-Orthopädie, Köln, Deutschland
  • Julia Keßling - Universitätsklinikum Köln, Unfallchirurgie-Orthopädie, Köln, Deutschland
  • Peter Knöll - Universitätsklinikum Köln, Unfallchirurgie-Orthopädie, Köln, Deutschland
  • Moritz Perrech - Universitätsklinikum Köln, Klinik für Neurochirurgie, Köln, Deutschland
  • Roland Goldbrunner - Universitätsklinikum Köln, Klinik für Neurochirurgie, Köln, Deutschland
  • Eren Celik - Universitätsklinikum Köln, Strahlentherapie, Köln, Deutschland
  • Max J. Scheyerer - Universitätsklinikum Köln, Unfallchirurgie-Orthopädie, Köln, Deutschland
  • Volker Neuschmelting - Universitätsklinikum Köln, Klinik für Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocP022

doi: 10.3205/22dgnc336, urn:nbn:de:0183-22dgnc3361

Veröffentlicht: 25. Mai 2022

© 2022 von Spreckelsen et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Decompressive surgery (DS) followed by radiotherapy (RT) is a vital part of the multimodal treatment approach in patients with symptomatic spinal metastases. (Patchell RA et al., Lancet, 2005). The therapy regime for patients without neurological deficits but impending paralysis due to epidural spinal cord compression (ESCC) is often set accordingly, yet data to justify additional DS over RT alone is scarce in this cohort. This study aims to analyze the impact of additional DS on clinical outcome of patients with low to intermediate ESCC.

Methods: We performed a single center, multidepartment retrospective analysis of patients treated for spinal epidural metastases from 2011-2021. Clinical characteristics and imaging data were evaluated. Neurological status was assessed by Frankel grade, ESCC was categorized according to the ESCC-scale. Low grade ESCC was defined as 1b and 1c, intermediate as 2 on the ESCC-scale. Spinal instrumentation surgery was only considered as DS if additional targeted decompression was performed. Significance was calculated with chi-square, Fisher’s exact or Mann-Whitney-U test. p<0.05 was defined as significant.

Results: ESCC-scale could be determined in 519 patients. Of these, 190 (36,6%) presented without neurological deficit (Frankel E) and low or intermediate ESCC-score (1b-2). Median follow up was 3 months, (min = 0, max = 79, SD 14.59 months). 36 (18.9%) presented with an ESSC of 1b, 43 (22.6%) with 1c and 111 (58.4%) with an ESSC-Score of 2. Surgical decompression and RT were performed in 147 (77.4%) of patients while 43 (22.6%) received either instrumentation and RT or RT alone. A reliable follow up was available for 171 of 190 patients. At last available follow up there was no significant difference in neurological outcome between the two groups (p=0.286). Neurological status worsened in 7 patients (5%) treated with surgical decompression and in 1 patient (3%) treated without decompression.

Conclusion: In our retrospective cohort, we could not find a general benefit of additional DS over RT alone regarding neurological outcome on short term follow up. Further subgroup analyses of clinical cofactors to be taken into account (e.g. radiosensitivity of the primary tumor) to identify the asymptomatic patients that may benefit from DS in particular are ongoing. Until then, our data suggest that indication for DS in asymptomatic patients with low or intermediate ESCC needs to be set cautiously.