Microsurgical Resection of Intramedullary Spinal Cord Metastases

Microsurgical Resection of Intramedullary Spinal Cord Metastases - a Retrospective International Multicenter Study

The aim of the study is to establish a multi-center, retrospective database for patients with intramedullary spinal cord metastases (ISCM) and analyse the functional outcome in surgically treated ISCM patients.

The hypothesis is that the surgical treatment of selected ISCM patients does not lead to persistent morbidity and does not increase mortality, compared to patients that are treated non-operatively.

Secondary objectives are to assess pre- to postoperative neurological deficits, ambulatory status, and overall survival of surgically treated ISCM patients.

The investigators intend to include a control cohort of patients with ISCM from participating centers, who underwent non-surgical oncological treatment (radiotherapy with or without chemotherapy). This control cohort of patients will be used to match patients with and without surgical treatment.

Primary endpoint (analysed in surgically treated ISCM patients):

Functional outcome at 90 days after treatment initiation, measured by the modified McCormick Scale. This is a score for grading of neurological function in spinal cord conditions.

The McCormick scale ranges from Grade I (neurologically intact) to grade V (paraplegic or quadriplegic). The McCormick scale is suitable for our retrospective study because of its good reproducibility and comparability.

Secondary endpoints (analysed in surgically treated ISCM patients and analysed in matched patients with and without surgical treatment):

• Functional outcome by the McCormick scale and the modified Japanese Orthopaedic Association scale (mJOA) at 6 and 12 months. This is a score evaluating motor function of upper and lower extremities, sensory function of upper extremities and sphincter function / voidance. The mJOA ranges from 0 - 18 points, with higher score values representing better functional outcome. The minimum clinically important difference of the mJOA is 1-2 points, and scores lower than 14 indicate moderate myelopathy, scores lower than 11 indicate severe myelopathy.
• Ambulatory status and continence at 90 days, 6 & 12 months (determined by mJOA subscores)
• Neurological outcome, measured by American Spinal Cord Injury Association (ASIA)
• Impairment Scale at 90 days, 6 and 12 months
• Rate & type of complications at 90 days after treatment according to The Novel Therapy
• Disability-Neurology Grade (TDN grade)16
• Overall survival (in days)

Inclusion Criteria:

• Adult patients admitted to one of the participating centres and treated for ISCM
• Available documentation of admission and postoperative status

Exclusion Criteria:

- Patients under the age of 18