Background: Patients with MSCC present with pain and/or neurological loss. NICE guidance recommends surgery to prevent paralysis or manage pain in paralysed patients. There is only one RCT comparing surgery with no surgery, which strongly recommends surgery, however, there have been advances in radiotherapy with better local control and lower normal tissue toxicity.

Objectives: To compare surgery with no surgery for neurological change, survival, length of stay and re-admissions.

Methods: A case-matched cohort study. To overcome the ethical difficulty of not offering surgery to MSCC patients; patients declining offered surgery were matched with patients proceeding with surgery. Twenty-seven patients declining surgery were matched to 54 receiving surgeries. Match criteria were in order by the primary tumour, presentation neurological grade (ambulatory, weight-bearing, bed-bound and paralysed), co-morbidities (ASA grade), age and gender. Data collected from the MSCC database, clinical letters and clinical coding. Statistical analysis used GraphPad Prism version 8.2.

Results: Matching accuracy was confirmed with no significant difference shown between the groups, p>0.6. Of those declining surgery, 3 improved and 3 deteriorated by 1 grade. Of those proceeding with surgery, improvement occurred in 1 by 2 grades and 5 by 1 grade; deterioration occurred in 3 by 2 grades and 9 by 1 grade. The net neurological grade change with no surgery was 0 whereas with surgery there was a loss of 8 grades (p=0.047).
At 3 months, survival rates were 83% in the surgery group and 61% in the no surgery group (p=0.05). The average initial length of stay in the surgery group was 21 vs. 10 days in the no surgery group (p<0>

Conclusion: Surgery resulted in a higher proportion of patients deteriorating neurologically and a longer length of stay but patients lived longer.

Keywords: Case-matched; Metastases; MSCC; Spinal metastases; Neurological outcomes