Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Abstract

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24-45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18-69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

Keywords: age; elderly; meningioma; neurosurgery; spinal meningioma; spine; surgery.

Figure 1

Illustration depicting how cross-sectional tumor area (yellow) and spinal canal area (blue) were calculated from preoperative magnetic resonance images (MRI). (A) shows the original MRI, and (B) shows the annotation of the tumor and spinal canal area.

Figure 2

Stacked bar chart and density plot, using data from the Swedish national cancer registry, highlighting the incidence and frequency of spinal meningiomas 2005–2017.

Figure 3

Kaplan-Meier survival curve of tumor recurrence or growth following surgical resection of spinal meningiomas.

Figure 4

Box plot depicting pre- and postoperative modified McCormick scale for the elderly and non-elderly cohort. The dot represents an outlier.

Figure 5

Bar chart showing preoperative symptoms in elderly (≥70 years) and non-elderly (18–69 years) patients, as well as the entire cohort, who underwent surgical resection of spinal meningiomas. Bold text indicates a statistically significant correlation (p < 0.05).

Figure 6

Bar chart showing preoperative modified McCormick scale in elderly (≥70 years) and non-elderly (18–69 years) patients, as well as the entire cohort, who underwent surgical resection of spinal meningiomas.