Metastatic epidural spinal cord compression approached by MRI: could it predict neurological peril?

Metastatic epidural spinal cord compression (MESCC) are the most serious debilitating morbidities of spine metastases (SpMs) causing devastating neurological damages. We still lack of reliable markers to predict neurological impairment.

A prospective cohort study collected 164 consecutive patients presenting with MESCC between January 2014-2021, divided in two groups: ambulatory (Frankel D-E) vs non-ambulatory (Frankel A-C). We compared the oncological and radiological characteristics of the MESCC in the 131 ambulatory patients to the 33 non-ambulatory patients.

The median Overall Survival (OS) for the ambulatory group was 15.6 months (SD = 2.1) vs 5.8 months (SD = 3.8) for the non-ambulatory group, p = 0.024. Forty-seven patients (28.7 %) were operated on: 23/131 (17.5 %) in the ambulatory group and 24/33 (72.7 %) in the non-ambulatory group, p = 0.001; hundred forty-four were treated with radiotherapy (87.8 %): 119/131 (90.8 %) in the ambulatory group and 25/33 (75.8 %) in the non-ambulatory group, p = 0.033. In multivariate analysis with multiple logistic regression, thoracic MESCC [OR: 0.2, 95 % CI 0.055-0.730; p = 0.015], and a vertical epiduritis-spine junction angle (VESJA) < 150° [OR: 0.231, 95 % CI 0.075-0.717; p = 0.011] were independent risk factors for impaired neurological function whereas SINS <7 was independently associated with good prognostic [OR: 3.787, 95 % CI 1.109-12.932; p = 0.034]. VESJA showed a strong interrater reliability with excellent interrater agreement (ICC: 0.83, 95 % CI: 0.74-0.89; κ: 0.85, 95 % CI: 0.73-0.96).

SINS <7, thoracic MESCC and VESJA showed to be independently associated with neurological prognosis. These factors could assist the neurosurgeon in their decision-making process regarding whether to perform surgery.