Favorable neurological recovery for MESCC-induced paralysis with median 9-day duration before surgery.

Purpose: This study aimed to evaluate the neurological outcomes of Metastatic epidural spinal cord compression (MESCC) patients who underwent decompressive surgery after experiencing over 48 h of paralysis.

Methods: This retrospective study hypothesizes that, unlike in cases of trauma and degenerative disorders where delayed decompression surgery often leads to poor outcomes, delayed decompression surgery for MESCC-induced paralysis yields relatively favorable results. This study included MESCC patients who had been paralyzed for more than 48 h and underwent decompressive surgery between January 2012 and December 2020. Data collected mainly included patient demographics, tumor pathologies, neurological function (Frankel grades), ambulatory status, and imaging manifestions. The primary outcome measure was neurological recovery.

Results: A total of 37 patients were included, with a median preoperative paralysis duration of 9 days. Following decompressive surgery, 30 patients (81.1%) improved by at least one Frankel grade. Specifically, 22 patients (59.5%) regained ambulatory ability. The percentages of patients with Frankel grades A, B, and C who regained ambulation after surgery were 28.6% (2 out of 7), 57.1% (8 out of 14), and 75.0% (12 out of 16), respectively.

Conclusions: Decompressive surgery is associated with significant neurological recovery in MESCC patients who have been non-ambulatory for more than 48 h. Surgical intervention remains beneficial even in cases of prolonged paralysis.