Postoperative Neurological Recovery and Risk Factor Analysis in Patients With Paralysis Due to Spinal Metastases

The primary outcome is the distribution and change in ASIA Impairment Grades at 1 month after surgery compared to baseline. The ASIA (American Spinal Injury Association) Impairment Scale categorizes spinal cord injury severity from Grade A (complete injury) to Grade E (normal motor and sensory function). An improvement is defined as a shift to a higher ASIA grade (e.g., from C to D or D to E). The proportion of patients showing at least 1-grade improvement will be calculated to reflect early neurological recovery following surgical decompression and stabilization for metastatic spinal cord compression.

Sex (male or female) will be recorded as a baseline demographic variable and may be analyzed for its association with neurological recovery after spinal metastasis surgery.

The patient's age at the time of surgery (in years) will be recorded to assess its relationship with postoperative neurological function and general prognosis.

Preoperative physical condition will be assessed using ASA (American Society of Anesthesiologists) classification and ECOG (Eastern Cooperative Oncology Group) score to explore their potential as predictors of surgical recovery and survival.

The interval (in months) from the initial diagnosis of the primary malignancy to the time of spinal surgery will be recorded to evaluate potential prognostic implications.

The time between the diagnosis of spinal metastasis and the surgical intervention will be measured in months to assess whether earlier surgical timing influences neurological outcomes.

Primary tumor pathology (e.g., lung adenocarcinoma, breast carcinoma, renal cell carcinoma) will be classified according to standard oncological criteria to investigate its impact on neurological recovery and survival.

Information on prior chemotherapy, radiotherapy, immunotherapy, and spinal or non-spinal surgeries will be documented to assess their association with surgical outcomes and functional recovery.

The vertebral level of metastasis, degree of bony destruction, and tumor extension into surrounding structures will be determined via imaging and intraoperative findings. These features will be analyzed in relation to postoperative ASIA outcomes.

Pain severity will be assessed preoperatively using the Visual Analog Scale (VAS), a 0-10 scale where higher scores indicate more severe pain. VAS scores will be used as a functional and prognostic indicator.

The patient's overall quality of life will be assessed using the EORTC QLQ-C30 (Version 3.0), a validated cancer-specific quality of life questionnaire developed by the European Organisation for Research and Treatment of Cancer. This instrument includes 30 items covering five functional domains (physical, role, cognitive, emotional, and social), three symptom domains (fatigue, pain, nausea/vomiting), a global health status/QoL scale, and six single items (dyspnea, appetite loss, sleep disturbance, constipation, diarrhea, and financial impact). Each domain or symptom score will be linearly transformed to a 0-100 scale according to the EORTC scoring manual. Higher scores for functional scales represent better functioning, while higher scores for symptom scales represent more severe symptoms.

The degree of spinal cord compression will be graded using the ESCC scale (grades 0-3) based on preoperative MRI, and the responsible spinal level (segment causing neurological dysfunction) will be identified. These factors will be analyzed for correlation with pre- and postoperative ASIA grade and recovery outcomes.

Spinal stability will be assessed using the Spinal Instability Neoplastic Score (SINS), which includes components such as pain, lesion location, bone quality, alignment, vertebral body collapse, and posterior involvement. The total score (0-18) will help stratify patients as stable, potentially unstable, or unstable and will be evaluated for its predictive value on surgical planning and outcomes.

Whole-body PET-CT will be used to identify the presence of visceral organ metastases and quantify the number and distribution of involved spinal levels. This information will be used to assess systemic tumor burden and analyze its relationship with neurological recovery and overall prognosis.

The ASIA (American Spinal Injury Association) Impairment Grade will be documented preoperatively to classify neurological status (Grade A to E) at baseline. This will serve as both a prognostic factor and reference for postoperative recovery analysis.

For patients presenting with incomplete paralysis, the interval between the onset of neurological weakness and the surgical intervention will be recorded in hours or days to assess the relationship between timing and functional outcomes.

Muscle spasticity will be graded using the Modified Ashworth Scale, a 6-point scale (0 to 4, with 1+) that measures resistance during passive soft-tissue stretching. This will assess upper motor neuron involvement and serve as a baseline and outcome parameter.

The total operative time will be measured in minutes, from skin incision to wound closure. It will be used as a surrogate for surgical complexity and will be correlated with perioperative risk and outcomes.

The anatomical spinal region (cervical, thoracic, lumbar, sacral) and specific vertebral levels subjected to decompression will be documented. These data will be used to assess the relationship between surgical site and neurological recovery.

The estimated amount of blood loss during surgery will be recorded in milliliters (mL). This variable reflects surgical invasiveness and will be correlated with transfusion requirements and postoperative complications.

Whether internal fixation devices (e.g., pedicle screws, rods, cages) were implanted will be documented (yes/no). This will be used to analyze the impact of mechanical stabilization on postoperative functional recovery.

The tumor removal method will be recorded as gross total resection, subtotal resection, or en bloc resection. The completeness of tumor removal will be analyzed for its association with local control and neurological outcomes.

Pathologic confirmation of the spinal metastatic lesion, including histologic type, surgical margins, and proliferation index (e.g., Ki-67), will be recorded. Pathology findings will be used for diagnostic confirmation and correlation with prognosis.