Introduction: Spinal vertebral metastases can lead to profound neurological impairments caused by compression of myelon, resulting in a notable reduction in both survival period and quality of life. Currently, there is no well-established evidence based protocol dictating the optimal timing and invasiveness for surgical interventions for the most favorable outcome.
Aims: The goal of this study is to ponder the indication of hyper-acute surgical interventions of patients with spinal vertebral metastases considering their period of survival and quality of life.
Methods: This study presents a retrospective clinical review of patients who underwent surgical treatment for spinal epidural neoplastic metastases from various origins spanning the years 2008 to 2022. Our database comprises 765 cases corresponding to 665 patients. Descriptive statistical analysis, survival analysis (log-rank, Kaplan-Meier tests), and Fisher’s exact tests were conducted using R-software.
Results: 8 distinct categories were delineated based on the time frame of the surgical intervention, which represent the duration between the onset of symptomatic progression and the surgical intervention. As a result no statistically significant discrepancies were found in survival rates between patients who underwent surgery within 48 hours versus patients who were operated on within one week (p=0.561). Furthermore, employing Kaplan-Meier analysis, three principal time-frame categories were identified: ≤1 week, 1 week-3 months, and ≥3 months, which exhibited considerable divergence in survival outcomes (p=0.0001).
Conclusion: According to our findings, patients subjected to urgent surgical intervention (within ≤48 hours) did not demonstrate a significant survival advantage compared to other time-framed groups. Therefore, the decision to conduct hyperacute on-call surgery warrants cautious deliberation. Furthermore, it is advisable to ensure the patients’ appropriate preoperative preparation, such as endovascular tumor embolization, correction of other internal medical impairments.
Funding: The authors did not recieve support from any organization for the submitted work.