Outcomes of Intramedullary Spinal Cord Tumor Surgery in Older Versus Younger Adults: A Multicenter Subanalysis Study by the Neurospinal Society of Japan

Abstract

Objective Intramedullary spinal cord tumors (IMSCTs) are uncommon and difficult to treat. Studies examining the efficacy of rare IMSCT surgery in the elderly are limited. We conducted a subanalysis using multicenter retrospective-historical data provided by the Japan Neurospinal Society to compare surgical outcomes between older and younger adults with IMSCTs. Methods We classified patients with IMSCTs into younger (aged 18–64 years) or older ( ≥ 65 years) groups. The primary outcomes of “improved” or “worsened” from the preoperative period to 6 months after surgery were evaluated using the modified McCormick scale (mMCs). A favorable outcome was defined as an mMCs grade of I/II at 6 months. Results Among 841 patients registered, there were 658 younger (78.2%) and 183 older patients (21.8%) evaluated using mMCs at 6 months. Median preoperative mMCs grades were significantly worse in older patients than in younger patients. Neither the “improved” nor “worsened” rate differed significantly between the groups (28.1% vs. 25.1%; crude odds ratio [cOR], 0.86; 95% confidence interval [CI], 0.59–1.25; adjusted OR [aOR], 0.84; 95% CI, 0.55–1.28; 16.9% vs. 23.0%; cOR, 1.47; 95% CI, 0.98–2.20; aOR, 1.28; 95% CI, 0.83–1.97). Favorable outcomes were significantly less common among older adults in the univariate analysis but were not significant in the multivariate analysis (66.4% vs. 53.0%; cOR, 0.57; 95% CI, 0.41–0.80; aOR, 0.77; 95% CI, 0.50–1.19). In both younger and older patients, preoperative mMCs accurately predicted favorable outcomes. Conclusion Age alone is not a sufficient reason to prohibit surgery for IMSCTs.

Keywords

• intramedullary spinal cord tumor
• modified mccormick scale
• older patients
• surgical outcome