Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord Compression
Abstract
:1. Introduction
2. Materials and Methods
2.1. Meta-Analysis Study Selection Process
“What are the rates of improved outcomes and adverse events rates for different timing of palliative surgery for acute symptomatic MSCC?”
- Adequate cohort assessment:
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- Age ≥ 18 years;
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- Patients with solid neoplasms with a known or unknown primary tumor;
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- Studies with contrast-enhanced spine magnetic resonance (MRI) and spine computer tomography (CT);
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- Patients with neurological impairment at admission (i.e., Frankel grade A to D and ASIA grade A to D);
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- Patients with >3 months of survival;
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- Decompressive/palliative surgery with or without posterior screw fixation.
- Outcome assessment:
- Adequate number of patients and timing:
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- Studies with patients with MSCC symptoms from 0 to 72 h.
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- Studies reporting outcomes based on timing of surgery from the beginning of symptoms as ≤24 h, >24 h, ≤48 h, and >48 h.
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- Minimum > 25 consecutive patients.
2.2. Evaluation of Methodological Quality for the Meta-Analysis
- Did the study include all or consecutive patients with adequate clinical follow-up?
- Was the outcome assessment objective and replicable?
- Was the sample size enough to draw valid statistical and clinical predictions?
2.3. Statistical Analysis
3. Results
Outcomes and Adverse Events
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Risk of Bias Domains | ||||||
---|---|---|---|---|---|---|
Study | D1 | D2 | D3 | D4 | D5 | Overall |
Meyer H et al., 2022 [13] | ||||||
Younsi A et al., 2021 [14] | ||||||
Younsi A et al., 2020 [15] | ||||||
Tateiwa D et al., 2019 [16] | ||||||
Lo WY et al., 2017 [17] | ||||||
Fan Y et al., 2016 [18] | ||||||
Quraishi NA et al., 2013 [19] |
Title | Author, Year | Journal | Recruitment | Country | Design | Cohort | Outcomes Scale | Numbers of Patients | Timing |
---|---|---|---|---|---|---|---|---|---|
Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome [13] | Meyer H et al., 2022 | Cancers | 2007–2019 | Germany | Retro | Acute symptomatic MSCC, solid tumors, palliative surgery | ASIA score | 46 | ≤24 h |
Feasibility of salvage decompressive surgery for pending paralysis due to metastatic spinal cord compression [14] | Younsi A et al., 2021 | Clinical Neurology and Neurosurgery | 2004–2014 | Germany | Retro | Acute symptomatic MSCC, solid tumors, palliative surgery | FRANKEL score | 28 | ≤24 h |
Impact of decompressive laminectomy on the functional outcome of patients with metastatic spinal cord compression and neurological impairment [15] | Younsi A et al., 2020 | Clinical & Experimental Metastasis | 2004–2014 | Germany | Retro | Acute symptomatic MSCC, solid tumors, palliative surgery | FRANKEL score | 101 | ≤48 h; >24 h |
Clinical outcomes and significant factors in the survival rate after decompression surgery for patients who were non-ambulatory due to spinal metastases [16] | Tateiwa D et al., 2019 | Journal of Orthopedic Science | 2011–2016 | Japan | Retro | Acute symptomatic MSCC, solid tumors, palliative surgery | FRANKEL score | 31 | ≤48 h; >48 h |
Metastatic spinal cord compression (MSCC) treated with palliative decompression: Surgical timing and survival rate [17] | Lo WY et al., 2017 | Plos One | 2012–2016 | Taiwan | Retro | Acute symptomatic MSCC, solid tumors, palliative surgery | FRANKEL score | 52 | ≤48 h; >48 h |
The timing of surgical intervention in the treatment of complete motor paralysis in patients with spinal metastasis [18] | Fan Y et al., 2016 | Eur Spine J | 2007–2014 | China | Retro | Acute symptomatic MSCC, solid tumors, palliative surgery | FRANKEL score | 33 | ≤48 h; >48 h |
Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression [19] | Quraishi NA et al., 2013 | Eur Spine J | 2005–2010 | United Kingdom | Retro | Acute symptomatic MSCC, solid tumors, palliative surgery | FRANKEL score | 166 | ≤24 h ≤48 h; >48 h |
Overall | ≤24 h | >24 h | ≤48 h | >48 h | |
---|---|---|---|---|---|
Patient N° | 538 | 270 | 212 | 222 | 197 |
IMPROVED NEUROLOGICAL DEFICIT % (95% CI) | 56.4 (35.0–77.6) | 41.3 (20.4–63.6) | 32.2 (12.4–55.8) | 83.0 (59.0–98.2) | 36.8 (12.2–65.4) |
COMPLICATIONS % (95% CI) | 19.8 (5.1–40.3) | 25.5 (15.9–36.3) | 28.6 (19.5–38.8) | 21.0 (1.8–51.4) | 28.6 (19.5–38.8) |
WOUND DEHISCENCE/DISCITIS % (95% CI) | 6.5 (1.2–15.0) | 7.1 (1.9–10.0) | 9.6 (1.8–21.2) | 7.9 (0.5–20.8) | 16.1 (9.3–24.3) |
EPIDURAL HEMATOMA % (95% CI) | 1.2 (0.0–3.5) | 3.6 (0.6–17.7) | / | 1.7 (0.0–5.5) | 0.0 (0.0–3.6) |
REOPERATION % (95% CI) | 1.4 (0.0–4.4) | / | / | 1.8 (0.0–5.4) | / |
30 days MORTALITY % (95% CI) | 0.1 (0.0–0.9) | / | 0.1 (0.0–21.5) | 0.1 (0.0–3.0) | / |
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Bresolin, N.; Sartori, L.; Drago, G.; Pastorello, G.; Gallinaro, P.; Del Verme, J.; Zanata, R.; Giordan, E. Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord Compression. Medicina 2024, 60, 631. https://doi.org/10.3390/medicina60040631
Bresolin N, Sartori L, Drago G, Pastorello G, Gallinaro P, Del Verme J, Zanata R, Giordan E. Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord Compression. Medicina. 2024; 60(4):631. https://doi.org/10.3390/medicina60040631
Chicago/Turabian StyleBresolin, Nicola, Luca Sartori, Giacomo Drago, Giulia Pastorello, Paolo Gallinaro, Jacopo Del Verme, Roberto Zanata, and Enrico Giordan. 2024. "Systematic Review and Meta-Analysis on Optimal Timing of Surgery for Acute Symptomatic Metastatic Spinal Cord Compression" Medicina 60, no. 4: 631. https://doi.org/10.3390/medicina60040631