title: Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC: Systematic Review.
abstract: METHODS
  Systematic literature review and expert survey OBJECTIVE.: The aim of this study was to determine factors associated with neurologic improvement in patients with neurologic deficits secondary to metastatic epidural spinal cord compression (MESCC). Clear understanding of these factors will guide surgical decision-making by helping to elucidate which patients are more likely to benefit from surgery and how surgeons can increase the probability of neurologic and functional restoration.
  
  
  BACKGROUND
  Surgical spinal cord decompression has been shown to improve neurologic function in patients with symptomatic MESCC. However, prognostication of neurologic improvement after surgery remains challenging, owing to sparse data and complexity of these patients.
  
  
  METHODS
  PubMed and Embase databases were searched for relevant publications. PRISMA Statement guided publication selection and data reporting. GRADE guidelines were used for evidence quality evaluation and recommendation formulation.
  
  
  RESULTS
  Low-quality evidence supports the use of the duration and severity of neurologic deficit as predictors of neurological recovery in patients with MESCC. Low-quality evidence supports the use of thoracic level of compression and previous irradiation as adverse predictors of neurological recovery. Nearly all of the AOSpine Knowledge Forum Tumor members who responded to the survey agreed that ambulation with assistance represented a successful surgical result and that duration of ambulation loss and the severity of weakness should be considered when trying to predict whether surgery would result in restoration of ambulation.
  
  
  CONCLUSIONS
  Review of literature and expert opinion support the importance of duration of ambulation loss and the severity of neurologic deficit (muscle strength, bladder function) in prediction of neurologic recovery among patients with symptomatic MESCC. Efforts to reduce the duration of ambulation loss and to prevent progression of neurologic deficits should be made to improve the probability of neurologic recovery.
  
  
  METHODS
  2.
authors.affiliation: Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Department of Orthopaedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bird
authors.affiliation: Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.affiliation: National Center for Spinal Disorders, Budapest, Hungary.
authors.forename: Áron
authors.initials: Á
authors.lastname: Lazáry
authors.affiliation: Centre for Spinal Studies & Surgery, Nottingham University Hospital, Queens Medical Center Campus, Nottingham, UK.
authors.forename: Nasir A
authors.initials: NA
authors.lastname: Quraishi
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto and Toronto, Western Hospital, Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, MA.
authors.forename: John H
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Orthopaedic Surgery and Oncology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.affiliation: Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
mesh_terms: D019299:Decompression, Surgical; D004824:Epidural Space / Q000601:surgery*; D006801:Humans; D020127:Recovery of Function / Q000502:physiology; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*