Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug;51(8):110285.
doi: 10.1016/j.ejso.2025.110285. Epub 2025 Jun 28.

Metastatic epidural spinal cord compression approached by MRI: could it predict neurological peril?

Quentin Beaufort  1 , Valentin Lefevre  1 , Jean-Philippe Cottier  1 , Ilyess Zemmoura  2 , Louis-Marie Terrier  3 , Aymeric Amelot  4
Affiliations

Metastatic epidural spinal cord compression approached by MRI: could it predict neurological peril?

Quentin Beaufort et al. Eur J Surg Oncol. 2025 Aug.

Abstract

Background: Metastatic epidural spinal cord compression (MESCC) are the most serious debilitating morbidities of spine metastases (SpMs) causing devastating neurological damages. We still lack of reliable markers to predict neurological impairment.

Methods: A prospective cohort study collected 164 consecutive patients presenting with MESCC between January 2014-2021, divided in two groups: ambulatory (Frankel D-E) vs non-ambulatory (Frankel A-C). We compared the oncological and radiological characteristics of the MESCC in the 131 ambulatory patients to the 33 non-ambulatory patients.

Results: The median Overall Survival (OS) for the ambulatory group was 15.6 months (SD = 2.1) vs 5.8 months (SD = 3.8) for the non-ambulatory group, p = 0.024. Forty-seven patients (28.7 %) were operated on: 23/131 (17.5 %) in the ambulatory group and 24/33 (72.7 %) in the non-ambulatory group, p = 0.001; hundred forty-four were treated with radiotherapy (87.8 %): 119/131 (90.8 %) in the ambulatory group and 25/33 (75.8 %) in the non-ambulatory group, p = 0.033. In multivariate analysis with multiple logistic regression, thoracic MESCC [OR: 0.2, 95 % CI 0.055-0.730; p = 0.015], and a vertical epiduritis-spine junction angle (VESJA) < 150° [OR: 0.231, 95 % CI 0.075-0.717; p = 0.011] were independent risk factors for impaired neurological function whereas SINS <7 was independently associated with good prognostic [OR: 3.787, 95 % CI 1.109-12.932; p = 0.034]. VESJA showed a strong interrater reliability with excellent interrater agreement (ICC: 0.83, 95 % CI: 0.74-0.89; κ: 0.85, 95 % CI: 0.73-0.96).

Conclusion: SINS <7, thoracic MESCC and VESJA showed to be independently associated with neurological prognosis. These factors could assist the neurosurgeon in their decision-making process regarding whether to perform surgery.

Keywords: ECOG; MESCC; Neurological impairment; Pathological; Spine metastasis; Surgery; Survival; Vertebral fracture.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest The authors declare that they have no personal conflicts of interest and no institutional financial interest in any drugs, materials, or devices described in this manuscript. The authors have no financial disclosures to report. In addition, patient gave informed consent for any medical and scientific investigations. This paper has not been published previously, is not under consideration for publication elsewhere. The authors declare that, if accepted, the paper will not be published elsewhere in the same form, in English or in any other language, without the written consent of the publisher.

LinkOut - more resources