{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:11:48Z","timestamp":1779297108441,"version":"3.51.4"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Delayed decompression for metastatic epidural spinal cord compression (MESCC) is a common real-world problem, yet short-interval recovery after patients have already remained nonambulatory for at least 48 h is poorly defined. We retrospectively evaluated 41 surgically selected patients with MRI-confirmed epidural MESCC (Bilsky grade 2\u20133) and preoperative nonambulatory neurological deficit (Frankel grades A\u2013C) lasting at least 48 h. The primary outcome was early neurological improvement, defined as a gain of at least one Frankel grade by postoperative days 10\u201314. The secondary outcome was early ambulation recovery, defined as postoperative Frankel grade D or E at the same interval. Early neurological improvement occurred in 20\/41 patients (48.8%), and early ambulation recovery occurred in 15\/41 (36.6%). No patient received postoperative index-level radiotherapy before the POD10\u201314 neurological assessment. Recovery was most common among patients with baseline Frankel grade C. In exploratory adjusted Firth-penalized models, ECOG performance status 3\u20134 was associated with lower odds of both outcomes. Rapid-growth tumors, classified using a pragmatic adapted growth-category framework, were associated with lower odds of early neurological improvement. Baseline Frankel grade C favored early ambulation recovery. Higher standardized HALP showed an exploratory association with early neurological improvement but did not alter the main clinical interpretation. Meaningful early recovery was observed in a subset of surgically selected MESCC patients despite delayed surgery, although these findings do not establish equivalence to earlier surgery or isolate the effect of surgery from multimodal oncologic care.<\/jats:p>","DOI":"10.3390\/curroncol33050299","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:45:34Z","timestamp":1779291934000},"page":"299","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Neurological Improvement and Ambulation Recovery After Delayed Surgery in Surgically Selected Nonambulatory Metastatic Epidural Spinal Cord Compression: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9552-8179","authenticated-orcid":false,"given":"Aydin Talat","family":"Baydar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3398-3846","authenticated-orcid":false,"given":"Baran","family":"Taskala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5400-7281","authenticated-orcid":false,"given":"Bahadir","family":"Topal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2411-0672","authenticated-orcid":false,"given":"Muhammed","family":"Bayindir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7064-8135","authenticated-orcid":false,"given":"Yunus Emre","family":"Batman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5548-2228","authenticated-orcid":false,"given":"Ilhan","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1000-2811","authenticated-orcid":false,"given":"Ali","family":"Dalgic","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medicana International Hospital, Ankara 06510, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"3366","DOI":"10.1200\/JCO.2005.04.754","article-title":"Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression","volume":"23","author":"Rades","year":"2005","journal-title":"J. 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