Risk factors for metastatic spinal cord compression in patients with spinal metastases: analysis of epidural...

Retrospective cohort study.

To identify whether the presence and features of epidural metastases are risk factors for metastatic spinal cord compression (MSCC).

Several factors are associated with the development of MSCC in patients with spinal metastases. However, the relationship between epidural metastasis and the development of MSCC is not well understood.

Among patients with spinal metastases at the spinal cord level treated at a single institution from 2017 to 2023, 191 cases (age: 66.4±12.9 years; sex: 120 male patients) were studied. We defined MSCC as a decrease of one or more grades in the American Spinal Injury Association (ASIA) impairment scale due to spinal metastases. Patients were diagnosed with epidural metastasis at the level of spinal metastasis. When the features of epidural metastases could be evaluated, the epidural spinal cord compression (ESCC) scale and circumferential angle of spinal cord compression (CASCC) were assessed. The risk factors for developing MSCC and high-risk epidural metastases were analyzed.

Of the patients with spinal metastases who developed MSCC during follow-up, 97.6% had epidural metastases before the onset of MSCC. Multivariate logistic regression analysis identified the presence of epidural metastasis as an independent risk factor for MSCC. In patients with evaluable epidural metastases, multivariate logistic regression analysis identified the ESCC scale and CASCC as high-risk factors. The cutoffs were determined to be 3 for the ESCC scale and 180° for CASCC.

Epidural metastasis was identified as a risk factor for MSCC in patients with spinal metastases. Additionally, epidural metastases in those with an ESCC scale of 3 and a CASCC greater than 180° were categorized as high-risk tumors.