Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC: Systematic Review

Ilya Laufer, Scott L. Zuckerman, Justin E. Bird, Mark Bilsky, Áron Lazáry, Nasir A. Quraishi, Michael G. Fehlings, Daniel Sciubba, John H. Shin, Addisu Mesfin, Arjun Sahgal, Charles G. Fisher

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: Systematic literature review and expert survey OBJECTIVE.: Determination of factors associated with neurologic improvement in patients with neurologic deficits secondary to MESCC. Clear understanding of these factors will guide surgical decision making by helping to elucidate which patients are more likely to benefit from surgery and how surgeons can increase the probability of neurologic and functional restoration. SUMMARY OF BACKGROUND DATA.: Surgical spinal cord decompression has been shown to improve neurologic function in patients with symptomatic MESCC. However, prognostication of neurologic improvement after surgery remains challenging, due to sparse data and complexity of these patients. METHODS.: PubMed and Embase databases were searched for relevant publications. PRISMA Statement guided publication selection and data reporting. GRADE guidelines were used for evidence quality evaluation and recommendation formulation. RESULTS.: Low-quality evidence supports the use of the duration and severity of neurologic deficit as predictors of neurological recovery in patients with MESCC. Low-quality evidence supports the use of thoracic level of compression and prior irradiation as adverse predictors of neurological recovery. Nearly all of the AOSpine Knowledge Forum Tumor members who responded to the survey agreed that ambulation with assistance represented a successful surgical result and that duration of ambulation loss and the severity of weakness should be considered when trying to predict whether surgery would result in restoration of ambulation. CONCLUSIONS.: Review of literature and expert opinion support the importance of duration of ambulation loss and the severity of neurologic deficit (muscle strength, bladder function) in prediction of neurologic recovery among patients with symptomatic MESCC. Efforts to reduce the duration of ambulation loss and to prevent progression of neurologic deficits should be made in order to improve the probability of neurologic recovery.Level of Evidence: 2

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Aug 3 2016

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Nervous System
Walking
Neurologic Manifestations
Publications
Expert Testimony
Muscle Strength
Decompression
PubMed
Spinal Cord
Decision Making
Urinary Bladder
Research Design
Thorax
Databases
Guidelines
Neoplasms
Surveys and Questionnaires

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Laufer, I., Zuckerman, S. L., Bird, J. E., Bilsky, M., Lazáry, Á., Quraishi, N. A., ... Fisher, C. G. (Accepted/In press). Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC: Systematic Review. Spine. https://doi.org/10.1097/BRS.0000000000001827

Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC : Systematic Review. / Laufer, Ilya; Zuckerman, Scott L.; Bird, Justin E.; Bilsky, Mark; Lazáry, Áron; Quraishi, Nasir A.; Fehlings, Michael G.; Sciubba, Daniel; Shin, John H.; Mesfin, Addisu; Sahgal, Arjun; Fisher, Charles G.

In: Spine, 03.08.2016.

Research output: Contribution to journalArticle

Laufer, I, Zuckerman, SL, Bird, JE, Bilsky, M, Lazáry, Á, Quraishi, NA, Fehlings, MG, Sciubba, D, Shin, JH, Mesfin, A, Sahgal, A & Fisher, CG 2016, 'Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC: Systematic Review', Spine. https://doi.org/10.1097/BRS.0000000000001827
Laufer, Ilya ; Zuckerman, Scott L. ; Bird, Justin E. ; Bilsky, Mark ; Lazáry, Áron ; Quraishi, Nasir A. ; Fehlings, Michael G. ; Sciubba, Daniel ; Shin, John H. ; Mesfin, Addisu ; Sahgal, Arjun ; Fisher, Charles G. / Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC : Systematic Review. In: Spine. 2016.
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