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Dynamics of Neurological Deficit After Surgical Decompression of Symptomatic Vertebral Metastases

Hessler, Christian MD*; Burkhardt, Till MD*; Raimund, Frank MD*; Regelsberger, Jan MD*; Vettorazzi, Eik; Madert, Juergen MD; Eggers, Christoph MD

doi: 10.1097/BRS.0b013e31819a825d
Clinical Case Series

Study Design. We conducted a retrospective study to examination the influence of preoperative duration of symptoms on the clinical outcome of patients that underwent surgical decompression because of neurologic deficit in metastatic disease of the spine.

Objectives. Our aim was to investigate possible correlations between the duration of neurologic deficit before surgery and postoperative outcome with respect to neural recovery in patients with spinal metastases, and second, based on those results, propose criteria for the timing of surgery in these patients.

Summary of Background Data. It has not yet been determined whether the duration of preoperative symptoms has an influence on the postoperative outcome of patients with vertebral metastases. A standardized treatment or protocol defining a strategy of surgical treatment has yet to be designed.

Methods. This study includes 194 patients. The duration of symptoms before surgical treatment and the neurologic status before and after operation were determined and classified according to the Frankel score.

Results. Of 401 patients, who underwent surgery due to metastases to the spine, 194 suffered from neurologic deficit. Analyzing the postoperative neurostatus in these patients revealed an improvement in 78 patients (40%), impairment in 13 patients (7%), and in 103 patients it did not change. The relation of duration of neurologic symptoms before surgery, and the outcome after an operation was highly significant (P < 0.001). In patients with less than 3 days of neurologic deficit, the probability of improvement in neurostatus was highly significantly higher (P < 0.001) than in patients with neurologic deficit existing for more than 15 days.

Conclusion. Patients with neurologic deficit because of spinal bone metastases benefit from early operative intervention. Urgent surgery is indicated in patients with less than 3 days of neurologic deficit.

We evaluated and compared the pre and postoperative neurostatus of 194 patients who underwent surgical decompression of the spine due to neurodeficit present in metastatic disease. The analysis of the results showed that patients with neurologic deficit due to spinal bone metastases benefit from early operative intervention.

From the Departments of *Neurosurgery and †Medical Biometry and Epidemiology, University Hospital, Hamburg, Germany; and ‡Department of Traumatology, General Hospital St. Georg, Hamburg, Germany.

Acknowledgment date: April 2, 2008. First revision date: July 11, 2008. Second revision date: August 22, 2008. Acceptance date: September 28, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Christian Hessler, MD, University Hospital Hamburg-Eppendorf, Department of Neurosurgery, Martinistrasse 52, 20246 Hamburg, Germany; E-mail: chessler@uke.uni-hamburg.de.

© 2009 Lippincott Williams & Wilkins, Inc.