For a study, the authors wanted to find out what factors influence neurological function following treatment so that clinicians may make better decisions about when and whether to undertake surgery on a spinal cavernous malformation (SCM). The authors conducted a retrospective observational cohort analysis of patients with SCM treated at their institution. The prognostic determinants of clinical outcome were determined using multiple logistic and Cox regression analyses. Frankel grade was used to determine neurological health.
A total of 112 patients satisfied the inclusion criteria, with 73 surgically treated patients and 39 conservatively managed patients completing a minimum of 24 months of follow-up. The SD lesion size was 8.7 5.2 mm on average. Preoperative lesion size of less than 5 mm (OR 13.62, 95% CI 1.05–175.98, p = 0.045), complete intramedullary lesion (OR 7.48, 95% CI 1.39–40.15, p = 0.019), and subarachnoid hemorrhage (OR 6.26, 95% CI 1.13–34.85, p = 0.036) were all independent predictors of poor outcome in the surgically treated Lesion size 10 mm (HR 9.77, 95% CI 1.18–80.86, p = 0.034), 3 segments with hemosiderin deposition (HR 13.73, 95% CI 1.94–97.16, p = 0.009), and subarachnoid hemorrhage (HR 13.44, 95% CI 2.38–75.87, p = 0.003) were all significant predictors of worse outcome in the conservative treatment group. The conservatively treated patients had a 4.3% yearly bleeding rate.
Independent risk factors for prognosis included subarachnoid hemorrhage, lesion size, morphology, amount of hemosiderin involvement, and motor impairment. They use these indicators in clinical practice to identify patients at a high risk of poor results. Patients with SCM should have a treatment strategy based on these risk factors and balanced with clinical symptoms.
Reference:thejns.org/spine/view/journals/j-neurosurg-spine/35/6/article-p824.xml
