Impact of spinal cord compression from intradural and epidural spinal tumors on perioperative symptoms-implications for surgical decision making.

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Spinal cord or cauda equina compression (SCC) is an increasing challenge in clinical oncology due to a higher prevalence of long-term cancer survivors. Our aim was to determine the clinical relevance of SCC regarding patient outcome depending on different tumor entities and their anatomical localization (extradural/intradural/intramedullary). We retrospectively analyzed 230 patients surgically treated for SCC. Preoperative status for pain and neurological impairment were correlated to the degree of compression, tumor location, and early as well as short-term follow-up outcome parameters. Interestingly, we did not observe any differences between intradural-extramedullary compared to extradural tumors. Unilaterally localized tumors were likely to present with pain (72.9%, p<0.01), whereas concentric growth was associated with motor deficits (41.0%, p<0.01, as primary symptom, 49.3% on admission, p<0.05). In concentric tumors, the pain pattern was diffuse (40.5% vs. 17.5 in unilateral disease, p<0.01), whereas unilateral tumors resulted in localized pain (61.4% local axial or radicular, p<0.01). Diffuse pain, patients without a sensory or motor deficit, progressive disease, cervical localization, and a higher degree of stenosis were identified as beneficial for an early improvement in pain (p<0.05). Notably, 29% of patients with unchanged pain and 30.8% with unchanged neurologic function at day 7 postoperative improved during follow-up (p<0.001). Our data demonstrate that the preoperative tumor anatomy in patients with SCC was closely related to their presenting symptoms and early clinical outcome. The detailed analysis elucidates the biology of SCC and might thereby aid in determining which patients will benefit from surgery.