Surgical treatment of metastatic epidural spinal cord compression: a systematic review and meta-analysis

Although surgery has become an important treatment modality for metastatic spinal tumors with epidural spinal cord compression (MESCC), its efficacy has not been systematically confirmed. This meta-analysis aimed to comprehensively evaluate the effectiveness of surgical treatment for MESCC and to examine the influence of patient characteristics on the incidence of postoperative complications.

A systematic search was conducted in PubMed, Embase, and the Cochrane Library for relevant studies published on or before March 5, 2025. A random-effects model was employed for data synthesis. Continuous outcomes were reported as standardized mean differences (SMD), while single-arm incidence rates were expressed as odds ratios (ORs) with 95 % confidence intervals (CIs). Subgroup analyses and leave-one-out sensitivity analyses were performed to explore sources of heterogeneity and the robustness of the results. Publication bias was assessed by visual inspection of funnel plot symmetry and statistical testing using Egger's and Begg's methods.

A total of 67 cohort studies comprising 5377 patients were included. The pooled incidence of postoperative complications was 23.0 % (95 % CI: 19.0 %-27.0 %). Specific complication rates were as follows: cerebrospinal fluid leakage, 4.0 % (95 % CI: 2.0 %-7.0 %); pneumonia, 5.0 % (95 % CI: 4.0 %-6.0 %); wound dehiscence, 3.0 % (95 % CI: 2.0 %-5.0 %); and wound infection, 5.0 % (95 % CI: 4.0 %-6.0 %). Clinically relevant outcomes demonstrated postoperative improvements in VAS, ODI, ECOG, and ESCC scores, while BI, KPS, and ASIA scores significantly increased compared to preoperative values.

Surgical intervention for MESCC appears to offer meaningful improvements in functional and clinical outcomes. However, the risk of postoperative complications remains non-negligible and is significantly influenced by patients' baseline characteristics. These findings should be interpreted with caution due to the limited number of events for some complications, but they nonetheless provide valuable insights for clinical decision-making in the management of metastatic spinal tumors.