# Quality-of-life and detailed functional outcome after IONM-aided microsurgical resection of cervical and thoracic intramedullary spinal cord tumors in adults

## TL;DR

This study examines quality-of-life and functional outcomes in patients who had spinal cord tumor surgery, finding that most maintained or improved their physical and mental health over time.

## Contribution

The paper provides detailed long-term quality-of-life and functional outcomes after surgery for cervical and thoracic spinal cord tumors in adults.

## Key findings

- 80% of patients had improved or stable motor function after surgery.
- Persistent sensory deficits and higher preoperative QoL were linked to worse physical QoL outcomes.
- Most patients maintained stable mental QoL and physical function over a median 25-month follow-up.

## Abstract

Resection is the therapy of choice for cervicothoracic intramedullary spinal cord tumors (ctIMSCTs). While coarse neurological outcome has been multiply reported, more detailed data on longer-term outcome of quality-of-life (QoL) aspects as well as functional and neurological status are still scarce.

We prospectively assessed all patients undergoing ctIMSCT surgery with IONM in our neurosurgical center between 2017 and 2023. Detailed neurological and functional status as well as McCormick Score, Barthel Index (BI) and physical & mental QoL via Short-Form-36-Health-Survey Score (SF36-P/MCS) were assessed pre- and immediately postoperatively and regularly during long-term follow-up (median: 25 months) and correlated with patients’ and tumor characteristics.

40 patients (m/f: 26/14) with a median age of 47 years were enrolled. In 78% and 22% of the patients tumors were located in the cervical and thoracic spine. Preoperatively, motor deficits were present in 40%, sensory disturbances in 78% and gait ataxia (proprioceptive deficits) in 38%; median McCormick Score was 1, mean SF36-PCS and SF36-MCS were 45.1 and 43.3, and median BI was 100 in the overall cohort. Gross-total resection rate was 88%. At last follow-up, 80% of the patients had a postoperative improved/stable course in motor, 25% in sensory and 75% in gait function compared to the preoperative status. The overall cohort’s median McCormick-Score was 1, while the mean SF36-PCS and SF36-MCS were 44.5 and 44.5 and the median BI was 100 (each with no significant differences compared to the preoperative status). Rates for individual improvement/stability/deterioration were 30%/33%/37% for physical QoL aspects and 33%/35%/32% for mental QoL aspects. Presence of a permanent postoperatively new/worsened sensory deficit (OR = 0.08; p = 0.01) and a preoperatively higher SF36-PCS (OR = 0.90; p = 0.01) were significantly associated with a worse follow-up outcome regarding physical QoL perception.

Quality-of-life and motor/gait function improves/stabilizes in the majority of patients during follow-up after ctIMSCTs resection. Persistence of a postoperative deterioration in sensory function and a higher preoperative QoL perception are factors associated with a worse physical QoL follow-up outcome.

The online version contains supplementary material available at 10.1007/s00701-026-06836-0.