Neurospine.
2022 Mar;19(1):43-50. 10.14245/ns.2142768.384.
Steroids in the Management of Preoperative Neurological Deficits in Metastatic Spine Disease: Results From the EPOSO Study
- Versteeg AL
1 - Elkaim LM2
- Sahgal A3
- Rhines LD4
- Sciubba DM5
- Schuster JM6
- Fehlings MG7
- Lazary A8
- Clarke MJ9
- Arnold PM10
- Bettegowda C5
- Boriani S11
- Gokaslan ZL12
- Fisher CG13
- Weber MH14
- AO Spine Knowledge Forum Tumor1
- Affiliations
-
- 1Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- 2Division of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- 3Department of Radiation Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, ON, Canada
- 4Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 5Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
- 6Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- 7Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- 8Spine Department, National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
- 9Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
- 10Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
- 11GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- 12Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island, USA
- 13Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
- 14Department of Surgery, McGill University, Montreal, QC, Canada
- KMID: 2528375
- DOI: http://doi.org/10.14245/ns.2142768.384
Abstract
Objective
Patients presenting with neurological deficit secondary to metastatic epidural spinal cord compression (MESCC) are often treated with surgery in combination with high-dose corticosteroids. Despite steroids being commonly used, the evidence regarding the effect of corticosteroids on patient outcomes is limited. The objective of this study was to describe the effect of corticosteroid use on preoperative neurological function in patients with MESCC.
Methods
Patients who underwent surgery between August 2013 and February 2017 for the treatment of spinal metastases and received steroids to prevent neurologic deficits were included. Data regarding demographics, diagnosis, treatment, neurological function, adverse events, health-related quality of life, and survival were extracted from an international multicenter prospective cohort.
Results
A total of 30 patients treated surgically and receiving steroids at baseline were identified. Patients had a mean age of 58.2 years (standard deviation, 11.2 years) at time of surgery. Preoperatively, 50% of the patients experienced deterioration of neurological function, while in 30% neurological function was stable and 20% improved in neurological function. Lengthier steroid use did not correlate with improved or stabilized neurological function. Postoperative adverse events were observed in 18 patients (60%). Patients that stabilized or improved neurologically after steroid use showed a trend towards improved survival at 3- and 24-month postsurgery.
Conclusion
This study described the effect of steroids on preoperative neurological function in patients with MESCC. Stabilization or improvement of preoperative neurological function occurred in 50% of the patients.
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