Hiroto Kageyama, Kotaro Tatebayashi, Shinichi Yoshimura, Toshiki Endo, Kazutoshi Hida, Masaki Mizuno, for the Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
Neurospine 2023;20(2):678-691. Published online June 30, 2023
Objective Intramedullary spinal cord tumors (IMSCTs) are uncommon and difficult to treat. Studies examining the efficacy of rare IMSCT surgery in the elderly are limited. We conducted a subanalysis using multicenter retrospective-historical data provided by the Japan Neurospinal Society to compare surgical outcomes between older and younger adults with IMSCTs.
Methods We classified patients with IMSCTs into younger (aged 18–64 years) or older ( ≥ 65 years) groups. The primary outcomes of “improved” or “worsened” from the preoperative period to 6 months after surgery were evaluated using the modified McCormick scale (mMCs). A favorable outcome was defined as an mMCs grade of I/II at 6 months.
Results Among 841 patients registered, there were 658 younger (78.2%) and 183 older patients (21.8%) evaluated using mMCs at 6 months. Median preoperative mMCs grades were significantly worse in older patients than in younger patients. Neither the “improved” nor “worsened” rate differed significantly between the groups (28.1% vs. 25.1%; crude odds ratio [cOR], 0.86; 95% confidence interval [CI], 0.59–1.25; adjusted OR [aOR], 0.84; 95% CI, 0.55–1.28; 16.9% vs. 23.0%; cOR, 1.47; 95% CI, 0.98–2.20; aOR, 1.28; 95% CI, 0.83–1.97). Favorable outcomes were significantly less common among older adults in the univariate analysis but were not significant in the multivariate analysis (66.4% vs. 53.0%; cOR, 0.57; 95% CI, 0.41–0.80; aOR, 0.77; 95% CI, 0.50–1.19). In both younger and older patients, preoperative mMCs accurately predicted favorable outcomes.
Conclusion Age alone is not a sufficient reason to prohibit surgery for IMSCTs.
Citations
Citations to this article as recorded by
Clinical predictors of overall survival in pediatric patients with intramedullary spinal tumors: an analysis of the SEER database Arjit Singh, Saarang Patel, Jacob Gould, Noah Yaffe, Guan Li, Lou Blanpain, Julian Gendreau Child's Nervous System.2026;[Epub] CrossRef
Intramedullary Spinal Cord Tumors in the Elderly Patient Max Ward, Ethan D.L. Brown, Apratim Maity, Sheng-Fu Larry Lo, Daniel M. Sciubba Neurosurgery Clinics of North America.2026; 37(3): 363. CrossRef
Surgical outcomes of cervical spinal cord tumor in elderly patients assessed by the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire Shuhei Ito, Narihito Nagoshi, Toshiki Okubo, Masahiro Ozaki, Satoshi Suzuki, Kazuki Takeda, Takahito Iga, Morio Matsumoto, Masaya Nakamura, Kota Watanabe Spinal Cord.2025; 63(5): 239. CrossRef
Current Treatment Outcomes for Intramedullary Spinal Cord Tumors in Japan Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Akira Ito, Tatsuya Sasaki Japanese Journal of Neurosurgery.2025; 34(6): 327. CrossRef
Prognostic Factors of Spinal Intramedullary Hemangioblastoma : Analysis of Surgical Outcomes and Tumor Characteristics Hyun-Jun Jang, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Dong-Kyu Chin, Yong-Eun Cho, Keun-Su Kim Journal of Korean Neurosurgical Society.2024; 67(6): 637. CrossRef
The Inside Story of the Multi–center Studies in the Neurospinal Society of Japan Keisuke Takai Spinal Surgery.2024; 38(2): 105. CrossRef
An overview of intramedullary spinal cord metastases accompanied by a 2D intraoperative video Nehemiah Stewart, Brandon Lee, George Bourdages, Michael Galgano Surgical Neurology International.2024; 15: 461. CrossRef
Current Trends and Future Perspective of Intramedullary Spinal Cord Tumor Treatments Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Tatsuya Sasaki Japanese Journal of Neurosurgery.2024; 33(6): 408. CrossRef
Objective This study aimed to analyze the clinical characteristics, treatment strategies, and surgical outcomes of subependymoma patients from the 2022 Neurospinal Society of Japan multicenter intramedullary spinal cord tumor study.
Methods Twenty-six patients with spinal cord subependymoma who were included in the index study of 1,033 patients were retrospectively analyzed.
Results Mean patient age was 49.4 years. Seventeen patients were men and 9 were women. Sensory disturbance was reported in 22 patients and motor weakness in 18. Median duration of symptoms was 24 months. The tumor was eccentrically located in 19 patients (73.1%) and unilateral in 17 (65.4%). Gross total resection was achieved in 6 patients (23.1%). The same rate for ependymoma patients in the index study was significantly higher (74.8%). Median follow-up was 40.5 months (interquartile range, 18–68 months). In 2 patients who underwent only partial resection, reoperation was required owing to progression 68 and 90 months after surgery, respectively. No recurrence occurred in patients who underwent gross total resection. Five patients experienced neurological worsening after surgery.
Conclusion Although spinal cord subependymoma can be difficult to distinguish from other intramedullary spinal cord lesions before surgery, it is characterized by an indolent clinical course and eccentric location. Surgical treatment should prioritize functional preservation because the prognosis is good even after subtotal resection.
Citations
Citations to this article as recorded by
Microsurgical removal of a C1-C5 laterally located intramedullary subependymoma through a postero-lateral sulcus approach: case report, surgical video and critical review of diagnostic and surgical challenges Ciro Mastantuoni, Antonio Bocchetti, Maria Rosaria Scala, Valentina Cioffi, Giuseppe Corazzelli, Salvatore Di Colandrea, Stefania Garofalo, Francesco Fiorentino, Rosa Della Monica, Lorenzo Chiarotti, Raffaele de Falco European Spine Journal.2026; 35(6): 3572. CrossRef
Rare Spinal Cord Tumors Daniel Lubelski, Lansaol Yang, Abdul Karim Ghaith Neurosurgery Clinics of North America.2026; 37(3): 389. CrossRef
Clinical characteristics and prognostic factors of primary spinal subependymoma: a single-center cohort study and systematic review Guang-Hao Zheng, Yao-Wu Zhang, Yi-Xiang Liu, Wei-Hao Liu, Bo Wang, Chong Wang, Kai Ji, Yong-Zhi Wang, Wen-Qing Jia Journal of Neuro-Oncology.2025; 172(3): 675. CrossRef
Genetic Markers and Mutations in Primary Spinal Cord Tumors and Their Impact on Clinical Management Rouzbeh Motiei-Langroudi Brain Sciences.2025; 15(10): 1028. CrossRef
Current Treatment Outcomes for Intramedullary Spinal Cord Tumors in Japan Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Akira Ito, Tatsuya Sasaki Japanese Journal of Neurosurgery.2025; 34(6): 327. CrossRef
First
Prev
