Medical Student Jordan University of Science and Technology Jordan University of Science & Technology
Disclosure(s):
Khaled J. Zaitoun, MBBS: No financial relationships to disclose
Introduction: Intramedullary spinal cord tumors (IMSCT) are rare but invasive tumors that can result in significant neurological impairment, and surgical resection is the primary treatment option. This study aims to investigate the progression of neurological function after surgical resection of IMSCTs and identify the factors that affect neurological status.
Methods: A random sample of the patients who underwent surgical resection of IMSCTs at Johns Hopkins Medical Institutions between 2004 and 2021 was included in this study. The sociodemographic, preoperative, and postoperative clinical characteristics, tumor features, and surgical details were collected. The modified McCormick Scale (mMS) changes of one degree or more were used to classify patients as ‘improved’ or ‘worsened.’ A backward stepwise binary logistic regression was employed to assess predictors of post-surgical progression.
Results: A total of 116 patients were included in this study, with a mean follow-up ± SD of 3.4±4.0 years. The mean (SD) age of patients was 38.0 (18.6), and 67 (57.8%) were men. More than half of patients (53.4%) had ependymoma, 37.9% had Astrocytoma, and 8.7% had hemangioblastoma. Approximately two-thirds of patients (62.1%) showed improvement in their mMS. Male gender and en-block resection of tumor were associated with favorable improvement outcomes, with OR of 2.83 (95% CI 1.07–7.50; p=0.036) and OR of 4.98 (95% CI 1.01–24.70, p=0.049), respectively. Meanwhile, high-grade IMSCT (OR 0.22, 95% CI 0.05–0.99; p=0.049), tumor location in the thoracolumbar region (OR 0.08; 95% CI 0.01–0.48; p=0.006), and longer hospital stay (OR = 0.92, 95% CI 0.85–1.00; p=0.049) were significant predictors for progression worsening. The age, body mass index, pre-operative neurological status, and tumor histology were not statistically significantly correlated with improvement or deterioration of the patient’s neurological status.
Conclusion : Gender, tumor grade, location, and type of resection were the essential predictors for improving neurological outcomes after surgical resection of IMSCTs.