Introduction: Corticosteroids are commonly used in metastatic spinal cord compression (MSCC) to reduce the inflammatory cascade, stabilize the vasculature at the site of compression, and reduce the occurrence of neurologic deficits.1,2 The effect of prolonged preoperative steroid use on requirements for rehabilitation in surgical patients, however, has not been reported. In this study, we analyze the influence of prolonged preoperative steroid use (>10 days) on the risk of requiring rehabilitation in functionally independent MSCC patients after surgery.

Methods: Functionally independent adult patients who underwent decompression for metastatic spinal tumors between 2005-2014 were identified in the National Surgical Quality Improvement Program Database. Demographic, preoperative risk factors, operative variables, and postoperative events were extracted for analysis. The primary outcome was requirement of rehabilitation. Multivariate logistical regression modeling was used to investigate the effects of steroid use in this cohort and identify other significant risk factors for requiring rehabilitation.

Results: 561 functionally independent patients underwent decompression for metastatic disease. Of these, 186 (33.16%) required rehabilitation. Steroid use was a significant risk factor for disposition to rehab (OR: 2.46, 95%CI: 1.37-4.37, p=0.002), with increased absolute difference in probability of 21.1% (49.9% steroid vs. 28.8% non-steroid). Other significant risk factors included ASA classification III-V (OR: 2.5, 95%CI: 1.43-4.35, p=0.001), emergent surgery (OR:2.18, 95%CI: 1.23-3.88, p=0.008) and older age (OR: 1.20, 95%CI:1.04-1.38, p=0.012). The model demonstrated strong predictive capacity, with an area under the curve of 0.73. No multicollinearity or confounding of the effect of steroid use by other covariates was present.

Conclusions: Prolonged preoperative steroid use is associated with over twice the risk of requiring rehabilitation in functionally independent surgical metastatic spine patients. Further investigations in to causal explanations are needed. However, this finding should result in thoughtful consideration of therapy duration when prescribing steroids for this patient population.

Patient Care: Provide neurosurgeons with evidence of the detrimental effects of prescribing steroids to functionally independent surgical metastatic spine tumor patients.

Learning Objectives: 1. Identify independently significant risk factors for requiring postoperative rehabilitation in functionally independent patients undergoing spine surgery for metastatic disease. 2. Understand prolonged steroid use is associated with an increased risk for requiring rehabilitation in functionally independent patients undergoing spine surgery for metastatic disease. 3. Obtain further knowledge about the risks of steroid use and consider judicious use in the future.

References: 1. Skeoch GD, Tobin MK, Khan S, Linninger AA, Mehta AI. Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review. Global spine journal. 2017;7(3):272-279. 2. George R, Jeba J, Ramkumar G, Chacko AG, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. The Cochrane database of systematic reviews. 2015(9):Cd006716.