{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:44:03Z","timestamp":1782953043788,"version":"3.54.5"},"reference-count":35,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"DFG","doi-asserted-by":"publisher","award":["491454339"],"award-info":[{"award-number":["491454339"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Surgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data on whether SD is beneficial are scarce. This study aims to investigate the neurological outcome of patients without neurological deficit, with a low- to intermediate-ESCC, who were treated with or without SD. Methods: This single-center, multidepartment retrospective analysis includes patients treated for spinal epidural metastases from 2011 to 2021. Neurological status was assessed by Frankel grade, and intraspinal tumor burden was categorized according to the ESCC scale. Spinal instrumentation surgery was only considered as SD if targeted decompression was performed. Results: ESCC scale was determined in 519 patients. Of these, 190 (36.6%) presented with no neurological deficit and a low- to intermediate-grade ESCC (1b, 1c, or 2). Of these, 147 (77.4% were treated with decompression and 43 (22.65%) without. At last follow-up, there was no difference in neurological outcome between the two groups. Conclusions: Indication for decompressive surgery in neurologically intact patients with low-grade ESCC needs to be set cautiously. So far, it is unclear which patients benefit from additional decompressive surgery, warranting further prospective, randomized trials for this significant cohort of patients.<\/jats:p>","DOI":"10.3390\/cancers15020385","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T04:47:08Z","timestamp":1673239628000},"page":"385","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Role of Decompressive Surgery in Neurologically Intact Patients with Low to Intermediate Intraspinal Metastatic Tumor Burden"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9873-1711","authenticated-orcid":false,"given":"Niklas","family":"von Spreckelsen","sequence":"first","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Ossmann","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Nadjiri","sequence":"additional","affiliation":[{"name":"Department of Radiooncology and Cyberknife Center, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0788-4681","authenticated-orcid":false,"given":"Moritz","family":"Lenschow","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergej","family":"Telentschak","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Ke\u00dfling","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kn\u00f6ll","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peer","family":"Eysel","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Goldbrunner","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Perrech","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Scheyerer","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eren","family":"Celik","sequence":"additional","affiliation":[{"name":"Department of Radiooncology and Cyberknife Center, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kourosh","family":"Zarghooni","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Neuschmelting","sequence":"additional","affiliation":[{"name":"Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Rades, D., Al-Salool, A., Staackmann, C., Cremers, F., Cacicedo, J., Lomidze, D., Segedin, B., Groselj, B., Jankarashvili, N., and Conde-Moreno, A.J. (2022). A New Clinical Instrument for Estimating the Ambulatory Status after Irradiation for Malignant Spinal Cord Compression. Cancers, 14.","DOI":"10.3390\/cancers14153827"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rades, D., Delikanli, C., Schild, S.E., Kristiansen, C., Tvilsted, S., and Janssen, S. (2022). A New Survival Score for Patients \u226565 Years Assigned to Radiotherapy of Bone Metastases. Cancers, 14.","DOI":"10.3390\/cancers14194679"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/S1474-4422(08)70089-9","article-title":"Metastatic epidural spinal cord compression","volume":"7","author":"Cole","year":"2008","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3388","DOI":"10.1200\/JCO.2005.05.0542","article-title":"Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression","volume":"24","author":"Rades","year":"2006","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.clon.2009.09.023","article-title":"A Population-based Study of Spinal Metastatic Disease in South-East Norway","volume":"21","author":"Zaikova","year":"2009","journal-title":"Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0936-6555(02)00400-4","article-title":"A population-based study of malignant spinal cord compression in Ontario","volume":"15","author":"Loblaw","year":"2003","journal-title":"Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0140-6736(05)66954-1","article-title":"Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: A randomised trial","volume":"366","author":"Patchell","year":"2005","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/2016.6.FOCUS16166","article-title":"Decompression surgery for spinal metastases: A systematic review","volume":"41","author":"Bakar","year":"2016","journal-title":"Neurosurg. Focus"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Rades, D., K\u00fcchler, J., Graum\u00fcller, L., Abusamha, A., Schild, S.E., and Gliemroth, J. (2022). Radiotherapy with or without Decompressive Surgery for Metastatic Spinal Cord Compression: A Retrospective Matched-Pair Study Including Data from Prospectively Evaluated Patients. Cancers, 14.","DOI":"10.3390\/cancers14051260"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Meyer, H.S., Wagner, A., Raufer, A., Joerger, A.-K., Gempt, J., and Meyer, B. (2022). Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome. Cancers, 14.","DOI":"10.3390\/cancers14092249"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1038\/sc.1969.30","article-title":"The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia","volume":"7","author":"Frankel","year":"1969","journal-title":"Spinal Cord"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1038\/sc.1994.13","article-title":"The international standards booklet for neurological and functional classification of spinal cord injury","volume":"32","author":"Ditunno","year":"1994","journal-title":"Spinal Cord"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"324","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability analysis of the epidural spinal cord compression scale","volume":"13","author":"Bilsky","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E1221","DOI":"10.1097\/BRS.0b013e3181e16ae2","article-title":"A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus From the Spine Oncology Study Group","volume":"35","author":"Fisher","year":"2010","journal-title":"Spine"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lenschow, M., Lenz, M., von Spreckelsen, N., Ossmann, J., Meyer, J., Ke\u00dfling, J., Nadjiri, L., Telentschak, S., Zarghooni, K., and Kn\u00f6ll, P. (2022). Impact of Spinal Instrumentation on Neurological Outcome in Patients with Intermediate Spinal Instability Neoplastic Score (SINS). Cancers, 14.","DOI":"10.3390\/cancers14092193"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1200\/JCO.2015.61.9338","article-title":"Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study","volume":"34","author":"Fehlings","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1007\/s00586-011-1867-6","article-title":"Surgery improves pain, function and quality of life in patients with spinal metastases: A prospective study on 118 patients","volume":"20","author":"Quan","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1097\/00007632-199909150-00014","article-title":"Complication, survival rates, and risk factors of surgery for metastatic disease of the spine","volume":"24","author":"Wise","year":"1999","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1302\/0301-620X.85B7.14201","article-title":"A population-based study of surgery for spinal metastases. Survival rates and complications","volume":"85","author":"Finkelstein","year":"2003","journal-title":"J. Bone Jt. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00590-019-02541-0","article-title":"Complications of spine surgery for metastasis","volume":"30","author":"Igoumenou","year":"2020","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.spinee.2018.05.037","article-title":"Complications and reoperations after surgery for 647 patients with spine metastatic disease","volume":"19","author":"Ogink","year":"2019","journal-title":"Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1097\/00007632-200208150-00021","article-title":"Surgery for solitary metastases of the spine: Rationale and results of treatment","volume":"27","author":"Sundaresan","year":"2002","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/BRS.0b013e318268ffc9","article-title":"Risk factors for medical complication after cervical spine surgery: A multivariate analysis of 582 patients","volume":"38","author":"Lee","year":"2013","journal-title":"Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1245\/s10434-016-5092-8","article-title":"Blood Loss and Transfusion Requirements in Metastatic Spinal Tumor Surgery: Evaluation of Influencing Factors","volume":"23","author":"Kumar","year":"2016","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13018-019-1348-x","article-title":"Neurological outcome of treatment for patients with impending paralysis due to epidural spinal cord compression by metastatic spinal tumor","volume":"14","author":"Maseda","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1038\/s41393-020-0432-8","article-title":"The clinical utility of the Spinal Instability Neoplastic Score (SINS) system in spinal epidural metastases: A retrospective study","volume":"58","author":"Dakson","year":"2020","journal-title":"Spinal Cord"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.1016\/j.spinee.2015.03.040","article-title":"The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale","volume":"15","author":"Quraishi","year":"2015","journal-title":"Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e567","DOI":"10.3928\/01477447-20200812-09","article-title":"Relationship Between Paralysis and the Epidural Spinal Cord Compression Scale in Spinal Metastasis","volume":"43","author":"Uei","year":"2020","journal-title":"Orthopedics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103","DOI":"10.21037\/atm.2018.01.28","article-title":"Minimally invasive versus conventional spine surgery for vertebral metastases: A systematic review of the evidence","volume":"6","author":"Pennington","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S1470-2045(11)70008-0","article-title":"Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: A multicentre, randomised controlled trial","volume":"12","author":"Berenson","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E3","DOI":"10.3171\/2017.5.FOCUS17175","article-title":"Cervical vertebroplasty for osteolytic metastases as a minimally invasive therapeutic option in oncological surgery: Outcome in 14 cases","volume":"43","author":"Stangenberg","year":"2017","journal-title":"Neurosurg. Focus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"7196","DOI":"10.1038\/s41598-017-07649-z","article-title":"Circulating tumour cell release after cement augmentation of vertebral metastases","volume":"7","author":"Mohme","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1634\/theoncologist.2012-0293","article-title":"The NOMS framework: Approach to the treatment of spinal metastatic tumors","volume":"18","author":"Laufer","year":"2013","journal-title":"Oncologist"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"216","DOI":"10.21037\/atm.2019.04.83","article-title":"Treatment, complications, and outcomes of metastatic disease of the spine: From Patchell to PROMIS","volume":"7","author":"Yahanda","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1038\/s41591-020-01195-4","article-title":"Targeting metastatic cancer","volume":"27","author":"Ganesh","year":"2021","journal-title":"Nat. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/2\/385\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:01:33Z","timestamp":1760119293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/2\/385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,6]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["cancers15020385"],"URL":"https:\/\/doi.org\/10.3390\/cancers15020385","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,6]]}}}