Thank you, AANS, for providing me with the opportunity to speak in this virtual session of Young Neurosurgeons Research Forum. I'm quite grateful to my team who gave me the opportunity to speak on their behalf. My name is Nidha Fatima and I'm a postdoc here at MGH. The topic that I'm going to discuss is early versus late decompression, does it affect neurological outcome, complications and survival in patients with metastatic spinal cord compression? We don't have any financial disclosures or any conflict of interest. As far as the background is concerned, we know that metastatic spinal cord compression is a debilitating clinical problem. These liens often require an expeditious treatment to relieve the cord compression and avoid further risk of vertebral collapse, spinal instability and neurological disability. Although corticosteroids and radiotherapy are efficacious in the management of metastatic spinal cord compression, however, direct decompressive surgery aims to improve the function outcome and ambulatory status in the real time emergency situations. Hence, the timing of surgical intervention is of paramount importance in preserving the functional capacity of the spinal cord. The optimal surgical timing of decompression in patients with metastatic spinal cord compression is still controversial. Therefore, we carried out this study with an aim and objective to determine the influence of timing of decompressive surgery on postoperative neurological outcome, complications and survival. This would help in clinician decision for the patients with metastatic spinal cord compression and aid in the development of new therapeutic and surgical strategies based upon these prognostic variables. After approval by IRB of MGH, a retrospective analysis of a prospectively maintained electronic database was carried out. We excluded patients with spinal metastasis without cord compression, treatment with either radiotherapy or radiosurgery alone, patients with prior surgery for bone metastasis and those with incomplete medical record. Neurological outcome was assessed through pre- and postoperative modified Frenkel grade. Surgical analysis was carried out using ANOVA-CHI-square and Kamplan-Meier estimate for survival analysis based upon the timing of decompression. We further divided our cohort based upon the timing of surgical intervention from the onset of acute neurological symptoms into three groups. First was the group one that was very early, less than 24 hours. Then we have group two, early from 24 to 48 hours and group three that was the late and it has greater than 48 hours. Furthermore, we did a subgroup analysis that was done by combining group one and group two as a group one, which was less than equal to 48 hours and group two greater than 48 hours. We included 119 patients who underwent decompression for metastatic spinal cord compression with 33.6% in group one, 23.5% of the patient in group two and 42.8% of the patients in group three. The median age of our cohort was 67 years with 63% of them being males. However, there was no statistically significant difference among the three groups. As far as the postoperative change in the modified Frenkel grade was concerned, we found that the major improvement was observed in patients who were treated within 24 hours compared to the other group and it was statistically significant. Same was seen among patients who were treated within 48 hours with statistically significant difference. The overall median survival after surgical intervention was 345 days. However, as we can see on Kaplan-Meier curve for both main group and subgroup analysis, there was no statistically significant difference in terms of median survival among the groups. 32 patients developed complications postoperatively, including wound infection and dehiscence, deep venous thrombosis, permanent amputation and instrumentation failure. However, it was statistically insignificant both for the main group and also towards the subgroup analysis. Multivariable regression analysis was carried out, which revealed that the poor preoperative modified Frenkel grade was a significant independent predictor of performing decompression within 24 hours of acute neurological symptoms by 14.7 folds. And also, poor preoperative Karnofsky scope was significantly associated with performance of decompression within 24 hours by 2.6 folds. Hence, our results showed that patients with decompression within 24 hours had better improvement in their postoperative neurological status, however, it does not influence complications and survival. Furthermore, our results showed that those patients who had poor preoperative neurology and performance status should undergo surgery within 24 hours of acute neurological symptoms. Further, prospective studies are needed to validate our results. Thank you so much. Again, thank you all for listening us.

decompressive surgery

metastatic spinal cord compression

neurological outcome

complications

survival