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Filling A Critical Gap in Metastatic Spine Care: A Novel Classification System for Neoplastic Cauda Equina Compression.
СтатьяНазвание и аннотация: Перевод в очереди
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Younus Iyan, Jain Harsh, Sarikonda Advith, Bonday Rida, Ahluwalia Ranbir, Zeoli Tyler, Jonzzon Soren, Peterson Keyan, Liles Campbell, Perrone Gabriel, Chanbour Hani, Nian Hui, Kelly Patrick, Lee Ryan, Dewan Michael, Luo Leo, Whitaker Ryan, Kohutek Zachary, Gaines Dakim, Bonfield Christopher, Lugo-Pico Julian, Abtahi Amir M, Stephens Byron F, Zuckerman Scott L
Аннотация
STUDY DESIGN: Cross-sectional survey and retrospective-cohort study (2010-21).
OBJECTIVES: We sought to:1) create a novel epidural cauda-equina compression (ECEC) grading system, 2) determine its inter/intrarater reliability, and 3) report its ability to predict preoperative neurologic status.
SUMMARY OF BACKGROUNDS DATA: While metastatic epidural spinal-cord compression is well characterized, ECEC remains poorly understood.
METHODS: Patients undergoing ECEC surgery were included. Severity was graded on axial MRI using a novel 4-point scale:Grade-0=Bone-only; Grade-1=Thecal sac indented<50% effaced; Grade-2=≥50% thecal sac effaced; Grade-3=Entire thecal sac effaced, no cerebrospinal fluid seen; +F modifier signified foraminal stenosis. Primary outcomes were inter/intrarater reliability, and the score's ability to predict baseline neurologic deficits. Reliability was assessed among spine surgeons, trainees, and radiation oncologists using intraclass correlation coefficient.
RESULTS: The survey included 9 spine-attendings, 7 trainees, and 4 radiation oncologists. Among 45 patients (mean age:61.6±10.6 y; 64.4% male), 15.5% each had Grade-1/2 compression, while 68.9% had Grade-3; foraminal stenosis was present in 82.2%. Grade 0-3: Overall inter/intrarater reliability was good at 0.635(95%CI:0.412-0.776) and 0.676(95%CI:0.503-0.810), with similar performance among spine-attendings (inter/intrarater:0.611;0.662), trainees (inter/intrarater:0.685;0.707), and radiation oncologists (inter/intrarater:0.634;0.679). Sensory deficits (28.6% vs. 28.6% vs. 16.1%,P=0.627), motor deficits (71.4% vs. 57.1% vs. 35.5%,P=0.171) and bowel/bladder disturbances (0% vs. 28.6% vs. 19.4%,P=0.346) were similar across grades. +F Modifier: Overall inter/intrarater reliability were poor at 0.350 (95%CI:0.180-0.505) and 0.391(95%CI:0.219-0.555), with fair reliability for spine-attendings (inter/intrarater:0.421;0.485), and trainees (inter/intrarater:0.414;0.443), and poor for radiation oncologists (inter/intrarater:0.259;0.299). Baseline neurological status showed no association with foraminal stenosis.
CONCLUSION: The novel ECEC grading system provides a reliable framework for characterizing metastatic ECEC, demonstrating good reliability for Grades-0-3 across spine surgeons, trainees, and radiation oncologists. Although compression grade was not associated with neurologic deficits, bowel/bladder deficit rates were non-significantly higher in Grades-2/3. Conversely, foraminal-modifier's poor reliability underscores limitations of static MRI in assessing foraminal stenosis. Overall, ECEC scale may enhance communication in describing neoplastic ECEC.
OBJECTIVES: We sought to:1) create a novel epidural cauda-equina compression (ECEC) grading system, 2) determine its inter/intrarater reliability, and 3) report its ability to predict preoperative neurologic status.
SUMMARY OF BACKGROUNDS DATA: While metastatic epidural spinal-cord compression is well characterized, ECEC remains poorly understood.
METHODS: Patients undergoing ECEC surgery were included. Severity was graded on axial MRI using a novel 4-point scale:Grade-0=Bone-only; Grade-1=Thecal sac indented<50% effaced; Grade-2=≥50% thecal sac effaced; Grade-3=Entire thecal sac effaced, no cerebrospinal fluid seen; +F modifier signified foraminal stenosis. Primary outcomes were inter/intrarater reliability, and the score's ability to predict baseline neurologic deficits. Reliability was assessed among spine surgeons, trainees, and radiation oncologists using intraclass correlation coefficient.
RESULTS: The survey included 9 spine-attendings, 7 trainees, and 4 radiation oncologists. Among 45 patients (mean age:61.6±10.6 y; 64.4% male), 15.5% each had Grade-1/2 compression, while 68.9% had Grade-3; foraminal stenosis was present in 82.2%. Grade 0-3: Overall inter/intrarater reliability was good at 0.635(95%CI:0.412-0.776) and 0.676(95%CI:0.503-0.810), with similar performance among spine-attendings (inter/intrarater:0.611;0.662), trainees (inter/intrarater:0.685;0.707), and radiation oncologists (inter/intrarater:0.634;0.679). Sensory deficits (28.6% vs. 28.6% vs. 16.1%,P=0.627), motor deficits (71.4% vs. 57.1% vs. 35.5%,P=0.171) and bowel/bladder disturbances (0% vs. 28.6% vs. 19.4%,P=0.346) were similar across grades. +F Modifier: Overall inter/intrarater reliability were poor at 0.350 (95%CI:0.180-0.505) and 0.391(95%CI:0.219-0.555), with fair reliability for spine-attendings (inter/intrarater:0.421;0.485), and trainees (inter/intrarater:0.414;0.443), and poor for radiation oncologists (inter/intrarater:0.259;0.299). Baseline neurological status showed no association with foraminal stenosis.
CONCLUSION: The novel ECEC grading system provides a reliable framework for characterizing metastatic ECEC, demonstrating good reliability for Grades-0-3 across spine surgeons, trainees, and radiation oncologists. Although compression grade was not associated with neurologic deficits, bowel/bladder deficit rates were non-significantly higher in Grades-2/3. Conversely, foraminal-modifier's poor reliability underscores limitations of static MRI in assessing foraminal stenosis. Overall, ECEC scale may enhance communication in describing neoplastic ECEC.