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Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord
Nicola Bresolin1, Luca Sartori1, Giacomo Drago1
1Department of Neuroscience, University of Padua, 35123 Padua, Italy.
Medicina (Kaunas, Lithuania)
|April 27, 2024
Summary
Urgent surgical decompression within 48 hours offers the best outcomes for metastatic spinal cord compression. This timing balances improved neurological function with reduced complication rates for patients with a good prognosis.
Area of Science:
- Neurosurgery
- Oncology
- Spinal Surgery
Background:
- Symptomatic acute metastatic spinal epidural cord compression (MSCC) is a critical condition requiring prompt intervention.
- Optimal surgical timing for MSCC remains debated, impacting patient outcomes.
Purpose of the Study:
- To systematically review and meta-analyze literature on surgical timing for symptomatic MSCC.
- To evaluate the impact of different surgical intervention windows on patient outcomes and adverse events.
Main Methods:
- Systematic review and random-effects meta-analysis of studies on adult MSCC patients undergoing decompression.
- Stratification of surgical timing into emergent (≤24h vs. >24h) and urgent (≤48h vs. >48h) categories.
- Analysis of neurological improvement and postoperative medical/surgical adverse events.
Main Results:
- Urgent decompression (≤48h) showed an 83.0% improvement in strength scores, with a 21% adverse event rate.
- Emergent surgery (<24h) had a 41.3% improvement rate but a 25.5% complication rate.
- Surgery after 48h was associated with 36.8% improvement and 28.6% complication rates.
Conclusions:
- A 48-hour surgical window appears to be the safest and most beneficial for acute MSCC patients with a life expectancy >3 months.
- Timely surgical decompression is crucial for maximizing functional recovery and minimizing risks in MSCC.
