Can we predict neurological complications in patients with metastatic spinal tumors?

Purpose: Thisstudy aimed to identify predictors of the occurrence and severity of neurological symptoms in patients with metastatic spinal tumor who still had noneurological symptoms. Methods: We retrospectively examined patients with metastatic spinal tumor (regardless of tumor type) who visited the Department of Rehabilitation Medicine between 2017 and 2021. Using the patients’ magnetic resonance imaging and clinical data, weinvestigated whether epidural spinal cord compression (ESCC) scale, spinal instability neoplastic score (SINS), and pain character were related to the occurrence and severity of neurological symptoms within 1 year. Results: Of the 70 included patients, 40 showedneurological symptoms, and 30 did not. Multivariable analysis showed that ESCC (2 or 3) (P = 0.002), SINS (P = 0.007), and radiating pain (P = 0.015) were associated with neurological complications. None of the factors was associated with neurological symptom severity. Notably, neurological symptoms progressed rapidly in patients with high ESCC (P = 0.003). Conclusion: ESCC, SINS, and radiating pain were related to the occurrence of neurological symptoms, but not to severity. Only ESCC was associated with the rapid progression of neurological symptoms. This retrospective study provides useful insights in predicting a patient's functional prognosis and determining management using radiology and clinical data.