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.

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