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KMID : 1145220230200020678
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Neurospine
2023 Volume.20 No. 2 p.678 ~ p.691
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Outcomes of Intramedullary Spinal Cord Tumor Surgery in Older Versus Younger Adults: A Multicenter Subanalysis Study by the Neurospinal Society of Japan
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Hiroto Kageyama
Kotaro Tatebayashi
Shinichi Yoshimura
Toshiki Endo
Kazutoshi Hida
Masaki Mizuno
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Abstract
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Objective : Intramedullary spinal cord tumors (IMSCTs) are uncommon and difficult to treat. Studies examining the efficacy of rare IMSCT surgery in the elderly are limited. We conducted a subanalysis using multicenter retrospective-historical data provided by the Japan Neurospinal Society to compare surgical outcomes between older and younger adults with IMSCTs.
Methods : We classified patients with IMSCTs into younger (aged 18?64 years) or older ( ≥ 65 years) groups. The primary outcomes of “improved” or “worsened” from the preoperative period to 6 months after surgery were evaluated using the modified McCormick scale (mMCs). A favorable outcome was defined as an mMCs grade of I/II at 6 months.
Results : Among 841 patients registered, there were 658 younger (78.2%) and 183 older patients (21.8%) evaluated using mMCs at 6 months. Median preoperative mMCs grades were significantly worse in older patients than in younger patients. Neither the “improved” nor “worsened” rate differed significantly between the groups (28.1% vs. 25.1%; crude odds ratio [cOR], 0.86; 95% confidence interval [CI], 0.59?1.25; adjusted OR [aOR], 0.84; 95% CI, 0.55?1.28; 16.9% vs. 23.0%; cOR, 1.47; 95% CI, 0.98?2.20; aOR, 1.28; 95% CI, 0.83?1.97). Favorable outcomes were significantly less common among older adults in the univariate analysis but were not significant in the multivariate analysis (66.4% vs. 53.0%; cOR, 0.57; 95% CI, 0.41?0.80; aOR, 0.77; 95% CI, 0.50?1.19). In both younger and older patients, preoperative mMCs accurately predicted favorable outcomes.
Conclusion : Age alone is not a sufficient reason to prohibit surgery for IMSCTs.
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KEYWORD
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Intramedullary spinal cord tumor, Modified McCormick scale, Older patients, Surgical outcome
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