Background: Delays in the diagnosis and treatment of metastatic epidural spinal cord compression (MESCC) can potentially result in serious, deleterious effects on patient outcomes and postoperative morbidity. Delays may occur any at any step in the chain of care, increasing the risk of preventable complications. Objectives: This study, thus, aims to identify patterns of treatment delays and determine the predictive factors of postoperative ambulatory function in patients with symptomatic MESCC. Methods: Adult patients, aged >18 years, who underwent surgical treatment for MESCC between 2015 and 2022, were included for analysis in this retrospective study. Results: A total of 177 patients were included. The most significant delay contributing to total delay was patient delay (mean duration 41 days) followed by diagnostic delay (mean duration 16 days). Patients presenting acutely to the Emergency Department and patients with neurological deficits were found to have significantly shorter delays. Preoperative neurological deficits (p = 0.001) and preoperative red flag symptoms of cord compression (p = 0.008) were significant factors that were predictive of postoperative functional independence. Referral delay was also a significant predictive factor (p = 0.013); surgical delay approached statistical significance (p = 0.075). Conclusions: The results of this study highlight the need for increasing patient education, enhancing physician management of patients with MESCC, and improving diagnostic efficiency to reduce delays and maximize patient outcomes.

Background: Delay in diagnosing metastatic epidural spinal cord compression (MESCC) adversely impacts clinical outcomes. High-grade MESCC is frequently overlooked on routine staging CT scans. We aim to assess the potential of our deep learning model (DLM) in detecting high-grade MESCC and reducing diagnostic delays. Methods: This retrospective review analyzed 140 patients with surgically treated MESCC between C7 and L2 during 2015–2022. An experienced radiologist (serving as the reference standard), a consultant spine surgeon, and the DLM independently classified staging CT scans into high-grade MESCC or not. The findings were compared to original radiologist (OR) reports; inter-rater agreement was assessed. Diagnostic delay referred to the number of days elapsed from CT to diagnostic MRI scan. Results: Overall, 95/140 (67.8%) patients had preoperative CT scans. High-grade MESCC was identified in 84/95 (88.4%) of the scans by the radiologist (reference standard), but in only 32/95 (33.7%) of the preoperative scans reported by the OR. There was almost perfect agreement between the radiologist and the surgeon (kappa = 0.947, 95% CI = 0.893–1.000) (p < 0.001), and between the radiologist and the DLM (kappa = 0.891, 95% CI = 0.816–0.967) (p < 0.001). In contrast, inter-observer agreement between the OR and all other readers was slight (kappa range = 0.022–0.125). Diagnostic delay was potentially reduced by 20 ± 28 (range = 1–131) days. Conclusions: The original radiologist reports frequently missed high-grade MESCC in staging CT. Our DLM for CT diagnosis of high-grade MESCC showed almost perfect inter-rater agreement with two experienced reviewers. This study is the first to demonstrate that the DLM could help reduce diagnostic delays. Further prospective research is required to understand its precise role in improving the early diagnosis/treatment of MESCC.

Purpose The Oxford Spinal Sarcoma Service is a designated primary spinal tumour referral centre in the United Kingdom serving over ten million residents. We report the outcomes of this centralised approach to primary spinal tumour care. Methods This is a retrospective review of surgically treated primary spinal tumour patients during 2008-2022. Patients were classified based on tumour resection margins - Enneking Appropriate (EA) or Enneking Inappropriate (EI). Outcomes studied include local recurrence and overall survival. Results 119 patients were included. 86/119(72%) cases involved the mobile spine; 33/119(28%), the sacrum. 96/119(81%) patients were virgin cases. EA margins were achieved in 68%(81/119) of cases. There were 38/119(32%) EI patients; 23/38(61%) were non-virgin cases which precluded EA resection. EA resection was achieved 90%(81/90) of the time when attempted. In EA patients with mobile spine tumours, local recurrence rate was 2%(1/51), vs. 18%(5/28) in EA patients with sacral tumours, 20%(7/35) in EI patients with mobile spine tumours, and 80%(4/5) in EI patients with sacral tumours. Mean local recurrence-free survival was 5.2(range 1-13.5) years; local recurrence rate, 18.5%(22/119). Mortality rate was 21.0%(25/119); mean overall survival was 5.63(range 1-13.5) years post-surgery. On multivariate analysis, EI margins and post-operative systemic treatment were significant predictors for local recurrence; presence of metastases and pre-operative systemic therapy, significant predictors for mortality. Conclusion Centralisation of primary spinal tumour care has led to excellent oncological results comparable to most large spinal tumour centres. In mobile spine primary tumours where EA margins were achieved, our local recurrence rate (2.0%) is one of the lowest reported in literature.