Quantitative Spinal Cord Deformation Is Associated with Neurologic Status in High-Grade Thoracic Metastatic Epidural Spinal Cord Compression: A Retrospective Surgical Cohort

Background/Objectives: Neurologic presentation varies among patients with high-grade metastatic epidural spinal cord compression (MESCC), even within Bilsky grades 2–3. We examined whether quantitative preservation of spinal cord caliber is associated with neurologic intactness at presentation.

Methods

We retrospectively studied 73 adults who underwent surgery for thoracic Bilsky grade 2–3 MESCC between June 2020 and December 2025. Preoperative neurologic status was classified as Frankel E versus Frankel A-D. Blinded observers measured anteroposterior and transverse cord diameters at maximal compression and at the first tumor-free cranial and caudal pedicle levels. A normalized two-adjacent cord compression ratio (CCR) was available in 71 patients. Modified Poisson regression estimated prevalence ratios for Frankel-E status, adjusted for Bilsky grade; logistic, Firth, and cranial-reference analyses were used as sensitivity analyses.