Metastatic Spinal Cord Compression as the First Manifestation of Malignancy – A Retrospective Study of Surgical Outcome from Single Institution Spine Tumor Registry

Given the limited studies addressing the issue about the effect of different surgical modalities for metastatic spinal cord compression (MSCC) as the first malignancy manifestation, we conducted a retrospective case-control study to evaluate the surgical outcome of MSCC as the first malignancy manifestation. A total of 59 patients who were suspected of having metastatic spinal cord compression and underwent surgery from 2008 to 2017 were enrolled in the study. All patients were categorized into either ‘debulking group’ or ‘palliative group’. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), Frankel scale, and Karnofsky scores. All the outcomes were analyzed with a data cutoff of December 31, 2017. There was a significant difference between groups in progression-free survival (PFS) (p = 0.0036). However, there was no significant difference between groups in the overall survival (OS) (p = 0.8669). Age of onset, gender, duration of symptoms, and location of spinal metastasis, initial Frankel, initial Tomita scores, and initial Karnofsky performance scale showed no significant differences between groups. In conclusion, debulking surgery was shown to provide better neurological recoveries and could be considered first in patients with metastatic spinal cord compression as the first malignancy manifestation.

115 An Audit on Dexamethasone Prescribing Practice on Surgically Managed Metastatic Spinal Cord Compression Patients in the Manchester Centre for Clinical Neurosciences: Lessons Learned in Closing the Loop

Metastatic Spinal Cord Compression is a surgical emergency owing to its propensity to cause significant morbidity and mortality. Dexamethasone is prescribed to reduce oedema and promote vascular membrane stabilization. The is done so until a more definitive management has been performed. This is a retrospective study evaluating the steroid-prescribing practice for MSCC patients in 2018 at a tertiary spinal unit in Greater Manchester. Thirty-three patients who underwent stabilisation were evaluated in terms of both steroid prescribing and weaning practices. Standards used against for both were the NICE guidelines and the Edinburgh/Christie’s guidelines. Of the 33 patients evaluated, only 1 patient received the correct loading dose of 16mg, whilst 27 went straight to being given 8mg BD. 5 did not receive dexamethasone at all. In terms of discontinuation/weaning, 26 were weaned accordingly and 2 were not weaned to continue as adjuvant treatment. Dexamethasone prescribing practises has since improved over the past two years. 93% of the patients have been correctly weaned as compared to 38% in the past. In terms of prescription, much needs to be done as almost all the patients evaluated did not get the correct loading dose despite receiving the appropriate maintenance.