@article{1b31c2630ea74a5fb9a55e95825385fb,
title = "Steroids in the Management of Preoperative Neurological Deficits in Metastatic Spine Disease: Results From the EPOSO Study",
abstract = "Objective: Patients presenting with neurological deficit secondary to metastatic epidural spinal cord compression (MESCC) are often treated with surgery in combination with high-dose corticosteroids. Despite steroids being commonly used, the evidence regarding the effect of corticosteroids on patient outcomes is limited. The objective of this study was to describe the effect of corticosteroid use on preoperative neurological function in patients with MESCC. Methods: Patients who underwent surgery between August 2013 and February 2017 for the treatment of spinal metastases and received steroids to prevent neurologic deficits were included. Data regarding demographics, diagnosis, treatment, neurological function, adverse events, health-related quality of life, and survival were extracted from an international multicenter prospective cohort. Results: A total of 30 patients treated surgically and receiving steroids at baseline were identified. Patients had a mean age of 58.2 years (standard deviation, 11.2 years) at time of surgery. Preoperatively, 50% of the patients experienced deterioration of neurological function, while in 30% neurological function was stable and 20% improved in neurological function. Lengthier steroid use did not correlate with improved or stabilized neurological function. Postoperative adverse events were observed in 18 patients (60%). Patients that stabilized or improved neurologically after steroid use showed a trend towards improved survival at 3-and 24-month postsurgery. Conclusion: This study described the effect of steroids on preoperative neurological function in patients with MESCC. Stabilization or improvement of preoperative neurological function occurred in 50% of the patients.",
keywords = "Metastasis, Neurological deficits, Outcomes, Spinal cord compression, Spine, Steroids",
author = "{AO Spine Knowledge Forum Tumor} and Versteeg, {Anne L.} and Elkaim, {Lior M.} and Arjun Sahgal and Rhines, {Laurence D.} and Sciubba, {Daniel M.} and Schuster, {James M.} and Fehlings, {Michael G.} and Aron Lazary and Clarke, {Michelle J.} and Arnold, {Paul M.} and Chetan Bettegowda and Stefano Boriani and Gokaslan, {Ziya L.} and Fisher, {Charles G.} and Weber, {Michael H.}",
note = "Funding Information: Conflict of Interest: Dr. Versteeg reports consulting and travel accommodations from AOSpine International. Dr. Sahgal reports past educational seminars with Elekta AB, Accuray Inc., and Varian medical systems; research grant kta AB; travel ac- commodations and expenses from Elekta and Varian; and belongs to the Elekta MR Linac Research Consortium. Dr. Rhines reports educational commitments with Stryker, which are outside the submitted work. Dr. Sciubba reports consulting and royalties from Medtronic, Depuy-Synthes, Stryker, Nuvasive, K2M, which are all outside the submitted work. Dr. Arnold reports travel accommodations and expenses from AOSpine North America; intellectual property rights and interests, equity, and position of responsibility from Evoke Medical; equity from Z-Plasty; consulting fees from Stryker Orthopaedics, Ulrich, Spine-guard, In Vivo Therapeutics, and In Vivo; and consulting fees, travel accommodations, and expenses from Stryker Spine, Spine-wave, Medtronic, which are all outside the submitted work. Dr. Gokaslan reports research support from AOSpine North America and stock ownership of Spinal Kinetics, which are all outside the submitted work. Dr. Fisher reports consulting and royalties from Medtronic; research grants from OREF; and fellowship support paid to institution from AOSpine and Medtronic, which are all outside the submitted work. No other relevant disclosures were reported. Funding Information: We are grateful to the collaborating centers{\textquoteright} local clinical research personnel and support staff for their active participation. The authors would like to thank Christian Knoll (AOCID statistician) for his statistical support. A research grant for this study was received from the Orthopaedic Research and Education Foundation (OREF). This study was organized and funded by AOSpine International, through the AOSpine Knowledge Forum Tumor, a pathology-focused working group of up to ten international spine experts acting on behalf of AOSpine in the domain of scientific expertise. Publisher Copyright: {\textcopyright} 2022 by the Korean Spinal Neurosurgery Society.",
year = "2022",
month = mar,
doi = "10.14245/ns.2142768.384",
language = "English (US)",
volume = "19",
pages = "43--50",
journal = "Neurospine",
issn = "2586-6583",
publisher = "Korean Spinal Neurosurgery Society",
number = "1",
}