Outcomes of Intramedullary Spinal Cord Tumor Surgery in Older Versus Younger Adults: A Multicenter Subanalysis Study by the Neurospinal Society of Japan

Abstract

Objective: Intramedullary spinal cord tumors (IMSCTs) are uncommon and difficult to treat. Studies examining the efficacy of rare IMSCT surgery in the elderly are limited. We conducted a subanalysis using multicenter retrospective-historical data provided by the Japan Neurospinal Society to compare surgical outcomes between older and younger adults with IMSCTs. Methods: We classified patients with IMSCTs into younger (aged 18–64 years) or older (≥ 65 years) groups. The primary outcomes of “improved” or “worsened” from the preoperative period to 6 months after surgery were evaluated using the modified McCormick scale (mMCs). A favorable outcome was defined as an mMCs grade of I/II at 6 months. Results: Among 841 patients registered, there were 658 younger (78. 2%) and 183 older patients (21.8%) evaluated using mMCs at 6 months. Median preoperative mMCs grades were significantly worse in older patients than in younger patients. Neither the “improved” nor “worsened” rate differed significantly between the groups (28. 1% vs. 25. 1%; crude odds ratio [cOR], 0. 86; 95% confidence interval [CI], 0. 59–1. 25; adjusted OR [aOR], 0. 84; 95% CI, 0. 55–1. 28; 16. 9% vs. 23. 0%; cOR, 1. 47; 95% CI, 0. 98–2. 20; aOR, 1. 28; 95% CI, 0. 83–1. 97). Favorable outcomes were significantly less common among older adults in the univariate analysis but were not significant in the multivariate analysis (66. 4% vs. 53. 0%; cOR, 0.57; 95% CI, 0.41–0.80; aOR, 0.77; 95% CI, 0.50–1.19). In both younger and older patients, preoperative mMCs accurately predicted favorable outcomes. Conclusion: Age alone is not a sufficient reason to prohibit surgery for IMSCTs.