• Yu Fan, Xi Zhou, Hai Wang, Pengxiang Jiang, Siyi Cai, Jianguo Zhang, and Yong Liu.
• Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
• Eur Spine J. 2016 Dec 1; 25 (12): 4060-4066.

PurposeThe timing of surgical intervention is important for ambulatory patients with metastatic epidural spinal cord compression (MESCC), while limited studies have focused on non-ambulant patients. The aim of this study was to investigate the proper timing of surgical intervention for paraplegic patients with MESCC.MethodsForty-three non-ambulant patients with MESCC who underwent posterior decompression were retrospectively reviewed. The neurological outcomes for pre-operative Frankel B patients with different interval window were further compared.ResultsNeurologic deficit improved by at least 1 Frankel grade in 37 patients who underwent surgery within 72 h (86.0 %). Overall, 18 pre-operative Frankel B patients became ambulatory again with an interval of less than 48 h, 15 pre-operative Frankel B patients remained non-ambulatory post-operatively with an interval longer than 48 h besides one with an interval of 8 h (P < 0.001). All nine pre-operative Frankel A patients remained non-ambulatory even though the interval window was less than 24 h.ConclusionThe timing of surgical intervention was key to predicting the post-operative outcome, and 48 h was suggested as the proper interval window for pre-operative Frankel B patients. These patients preserved sensory function which might be a predictor. And the sooner the surgery was performed, the better the result would be.

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