Prediction of outcomes for symptomatic spinal cavernous malformation surgery: a multicenter prospective clinical study

Abstract

Abstract Objective: Clinical outcome of spinal cavernous malformation (SCM) varies because of its unclear natural history and reliable prognostic prediction model for SCM patients is limited. The aim of the present study was to investigate potential factors that predict one year neurological status in postoperative patients with SCM.Methods: This was a multicenter prospective observational study in consecutive patients with SCMs. SCMs treated microsurgically between January 2015 and January 2021 were included. Outcome was defined as Frankel Scale (ranging from A to E) at one year after operation. Multivariable analyses were used to construct the best predictive model for patient outcomes.Results: We identified 268 eligible SCM patients. Neurological outcome had worsened from preoperative baseline in 51 patients (19.0%) at one year. In the multivariable logistic regression, the best predictive model for unfavorable outcome included symptom duration ≥ 26 moths (95% CI: 2.80-16.96, P < 0.001), size ≤5 mm (95% CI: 1.43-13.50, P = 0.010), complete intramedullary (95% CI: 1.69-8.14, P = 0.001), subarachnoid hemorrhage (95% CI: 2.92-12.57, P < 0.001), Frankel Grade B (95% CI: 1.91-40.93, P = 0.005) and Frankel Grade C (95% CI: 1.12-14.54, P = 0.033).Conclusions: Admission size of the lesion, morphology, symptom duration, Frankel Grade and the presence of subarachnoid hemorrhage were strong outcome predictors regarding prognostication of neurological outcome in postoperative patients with SCMs. A decision to surgically remove a symptomatic SCM should be justified by systematic analysis of all factors potentially affecting outcome.