The timing of surgical intervention in the treatment of complete motor paralysis in patients with spinal metastasis.

Abstract

The timing of surgical intervention is important for ambulatory patients with metastatic epidural spinal cord compression (MESCC), while limited studies have focused on non-ambulant patients. The aim of this study was to investigate the proper timing of surgical intervention for paraplegic patients with MESCC. Forty-three non-ambulant patients with MESCC who underwent posterior decompression were retrospectively reviewed. The neurological outcomes for pre-operative Frankel B patients with different interval window were further compared. Neurologic deficit improved by at least 1 Frankel grade in 37 patients who underwent surgery within 72h (86.0%). Overall, 18 pre-operative Frankel B patients became ambulatory again with an interval of less than 48h, 15 pre-operative Frankel B patients remained non-ambulatory post-operatively with an interval longer than 48h besides one with an interval of 8h (P<0.001). All nine pre-operative Frankel A patients remained non-ambulatory even though the interval window was less than 24h. The timing of surgical intervention was key to predicting the post-operative outcome, and 48h was suggested as the proper interval window for pre-operative Frankel B patients. These patients preserved sensory function which might be a predictor. And the sooner the surgery was performed, the better the result would be.