Steroids in the Management of Preoperative Neurological Deficits in Metastatic Spine Disease: Results From the EPOSO Study
Anne L. Versteeg,
Lior M. Elkaim,
Arjun Sahgal,
Laurence D. Rhines,
Daniel M. Sciubba,
James M. Schuster,
Michael G. Fehlings,
Aron Lazary,
Michelle J. Clarke,
Paul M. Arnold,
Chetan Bettegowda,
Stefano Boriani,
Ziya L. Gokaslan,
Charles G. Fisher,
Michael H. Weber,
Affiliations
Anne L. Versteeg
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
Lior M. Elkaim
Division of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
Arjun Sahgal
Department of Radiation Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, ON, Canada
Laurence D. Rhines
Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Daniel M. Sciubba
Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
James M. Schuster
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Michael G. Fehlings
Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
Aron Lazary
Spine Department, National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
Michelle J. Clarke
Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
Paul M. Arnold
Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA
Chetan Bettegowda
Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
Stefano Boriani
GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Ziya L. Gokaslan
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island, USA
Charles G. Fisher
Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada
Michael H. Weber
Department of Surgery, McGill University, Montreal, QC, Canada
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.
