Clinical characteristics and surgical outcomes of adult primary spinal cord tumors: A 10-year experience

Adult primary spinal tumors (PST) are under-reported, particularly in low- and middle-income countries, including Pakistan. Notably, despite the limited availability of Intraoperative neurophysiological monitoring (IONM), we safely managed 137 patients with spinal cord tumors at a tertiary center over 10 years. We retrospectively reviewed demographic, neurological status (i.e., evaluation using Modified McCormick Scale preoperatively/postoperatively), surgical outcomes, and progression-free survival (PFS) for 137 patients operated for primary spinal cord tumors over 10 years. These 137 patients with mean age 40.8 ± 15.1 years were followed up for an average of 8.7 months after surgery. Pre-operative common symptoms included lower extremity weakness (61, 44.5%) and back pain (50, 36.5%). Tumors were located mainly in the cervical (49, 36.6%) and thoracic spine (43, 32.1%). With IONM use in 29 (21.5%) patients, gross total resection (GTR; 25 [86.2%]) was achieved for the majority of tumors. IONM was not available for 106 patients. Of the latter, 90 (85.0%) had GTR. Notably, GTR was the only significant predictor of PFS ($P = 0.03$). At last follow-up, MMS improved in 97 (70.8%) of patients, was unchanged in 25 (18.2%), and worsened in 15 (11.0%). We found in Pakistan that many of the 137 patients with spinal cord tumors presented late in their clinical course, often with significant neurological deficits; this highlights the need for earlier and better diagnostic capacity and referral pathways. Despite limited IONM availability due to limited resources, GTR rates and neurological improvement were achieved. Nevertheless, we still advocate using IONM where resources allow.