Tumour Size and Early Post-operative Ambulation are Associated with Functional Outcomes in Thoracic Spinal Meningiomas

Introduction: Thoracic spinal meningiomas (TSM) are the most common primary spinal tumour, with surgery being standard treatment. Post-operative neurological outcomes are generally favourable, but some patients experience severe post-operative deficits. We aim identify predictive factors of neurological outcomes in a South-East Asian cohort of patients who underwent surgical treatment for TSM.

Methods: A retrospective review of patients in two tertiary institutions who underwent surgical treatment of TSM from January 2015 to December 2023 was conducted. The primary outcome assessed was neurological outcome at 6 months post-operatively, measured by ASIA Motor score (AMS), and the modified Japanese Orthopedic Association-thoracic myelopathy (mJOA-TM) score. Secondary outcome was post-operative complications. Univariate and multivariate regression analysis was performed to identify predictive factors for these outcomes.

Results: 74 patients were included. The average age was 64.4 years (SD = 13.1), and 93.2% were female. The mean AMS at presentation was 93.3 (SD = 6.5) and median mJOA-TM was 8 (IQR = 2). Post-operative complications were observed in 25.7% patients. At six months post-operatively, the average AMS was 96.6 (SD = 9.2), and the median mJOA-TM score was 10 (IQR = 2). Factors significantly associated with poorer AMS at six months included anterior-posterior tumor length (Beta 2.57, p < 0.01), transverse tumor length (Beta 3.08, p < 0.01), need for inpatient rehabilitation (Beta -1.19, p < 0.01), and worsened incontinence (Beta -3.80, p < 0.01). Delayed ambulation (Beta 0.06, p < 0.01) and inpatient rehabilitation (Beta 0.52, p < 0.01) were associated with poorer mJOA-TM outcomes. No significant associations were found on multivariate analysis for the secondary outcome.

Conclusion : Larger tumor size, worsened incontinence, delayed ambulation, and the need for inpatient rehabilitation are significant predictors of poor neurological recovery following TSM surgery. Early intervention and targeted rehabilitation may help improve outcomes for these patients.