Specifics of Epidural Compression Syndrome Surgery in Patients with Spinal Malignancy

Background. Epidural spinal cord compression (ESCC) is the most common neurological complication in metastatic spinal tumours.

Materials and methods. The study included 87 spinal malignancy patients operated within 01.01.2014–30.09.2021. All patients had a  type of palliative decompressive and stabilising surgery: standard posterior access (SPA, 55  patients), minimally invasive posterior access (MPA, 22 patients) or anterior access (AA, 10 patients).

Results. The patient cohorts did not differ significantly by the duration of surgery, length of hospital stay, rates and types of postoperative complications. The AA cohort revealed a statistical difference by intraoperative blood loss. A Karnofsky performance status was statistically improved post- vs. pre-surgery (p < 0.05) at no significant change of Frankel neurological function status (p > 0.05). A Kaplan — Meier curve analysis showed no significant survival rate variation among the surgical techniques. Discussion. Our results suggest that posterior access interventions should be considered optimal. We report no statistical difference in the postoperative neurological and performance status dynamics between both cohorts, which encourages the MPA use in all patients with minimal epidural compression.

Conclusion. Posterior access with cytoreductive tumour removal in anterior spinal cord compression is advantageous over anterior surgery. A posterior access surgery with minimal spinal canal decompression is recommended in all patients with grade 1 tumoural epidural compression. 

1. Kit O.I., Balyazin-Parfenov I.V., Balyazina E.V., Balyazin V.A. Franzyants E.M., Rostorguev E.E., et al. Tumors penetrating into the cranial cavity and spinal canal. In: Cytological, morphological and immunohistochemical diagnostics of tumors of the central nervous system. Novocherkassk: Lik; 2015. 156 p. (In Russ.).

2. Bilsky M.H., Laufer I., Fourney D.R., Groff M., Schmidt M.H., Varga P.P., et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324-8. DOI: 10.3171/2010.3.SPINE09459.

3. Younsi A., Riemann L., Scherer M., Unterberg A., Zweckberger K. Impact of decompressive laminectomy on the functional outcome of patients with metastatic spinal cord compression and neurological impairment. Clin Exp Metastasis. 2020;37(2):377-390. DOI: 10.1007/s10585-019-10016-z.

4. Patchell, R.A., Tibbs P.A., Regine W.F., Payne R., Saris S., Kryscio R.J., et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):43-648. DOI: 10.1016/S0140-6736(05)66954-1.

5. Al-Omair A., Masucci L., Masson-Cote L., Campbell M., Atenafu E.G., Parent A., et al. Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy. Neuro Oncol. 2013;15(10):1413-9. DOI: 10.1093/neuonc/not101.

6. Uei H., Tokuhashi Y., Maseda M. Analysis of the relationship between the epidural spinal cord compression (ESCC) scale and paralysis caused by metastatic spine tumors. Spine (Phila Pa 1976). 2018;43(8):E448- E455. DOI: 10.1097/BRS.0000000000002378.

7. Maseda M., Uei H., Nakahashi M., Sawada H., Tokuhashi Y. Neurological outcome of treatment for patients with impending paralysis due to epidural spinal cord compression by metastatic spinal tumor. J Orthop Surg Res. 2019;14(1):291. DOI:10.1186/s13018-019-1348-x.

8. Uei H., Tokuhashi Y., Maseda M., Nakahashi M., Sawada H., Nakayama E., et al. Comparison between minimally invasive spine stabilization with and without posterior decompression for the management of spinal metastases: a retrospective cohort study. J Orthop Surg Res. 2018;13(1):87. DOI: 10.1186/s13018-018-0777-2.

9. Jung J.M., Chung C.K., Kim C.H., Yang S.H. Minimally invasive surgery without decompression for hepatocellular carcinoma spinal metastasis with epidural spinal cord compression grade 2. J Korean Neurosurg Soc. 2019;62(4):467-475. DOI: 10.3340/jkns.2018.0199.

10. Conti A., Acker G., Kluge A., Loebel F., Kreimeier A., Budach V., et al. Decision making in patients with metastatic spine. The role of minimally invasive treatment modalities. Front Oncol. 2019;9:915. DOI: 10.3389/fonc.2019.00915.

11. Kit O.I., Voshedskii V.I., Sakun P.G., Gusareva M.A., Vlasov S.G., Museiko K.N., et al. Novalis Tx radiosurgical platform experience in National Medical Research Centre for Oncology of the Ministry of Health of Russian. South Russian Journal of Cancer. 2020;1(4):32-37. (In Russ.) DOI:10.37748/2687-0533-2020-1-4-4.

12. Barzilai O., Robin A.M., O’Toole J.E., Laufer I. Minimally invasive surgery strategies: changing the treatment of spine tumors. Neurosurg Clin N Am. 2020;31(2):201-209. DOI: 10.1016/j.nec.2019.11.003.