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Application of the NSE score (Neurology-Stability-Epidural compression assessment) to establish the need for surgery in spinal metastases of elderly patients: a multicenter investigation

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This retropective multicentric study aims to investigate the clinical applicability of the NSE score in the elderly, to verify the role of this tool as an easy help for decision making also for this class of patients.


All elderly patients (> 65 years) suffering from spinal metastases undergoing surgical or non-surgical treatment at the authors’ Institutions between 2015 and 2022 were recruited. An agreement group (AG) and non-agreement group (NAG) were identified accordingly to the agreement between the NSE score indication and the performed treatment. Neurological status and axial pain were evaluated for both groups at follow-up (3 and 6 months). The same analysis was conducted specifically grouping patients older than 75 years.


A strong association with improvement or preservation of clinical status (p < 0.001) at follow-up was obtained in AG. The association was not statistically significant in NAG at the 3-month follow-up (p 1.00 and 0.07 respectively) and at 6 months (p 0.293 and 0.09 respectively). The group of patients over 75 years old showed similar results in terms of statistical association between the agreement group and better outcomes.


Far from the need or the aim to build dogmatic algorithms, the goal of preserving a proper performance status plays a key role in a modern oncological management: functional outcomes of the multicentric study group showed that the NSE score represents a reliable tool to establish the need for surgery also for elderly patients.

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This study is a prosecution of previous work on the application of the validated NSE score for which the Resident and Fellow Research Award NASS was received in 2022 NASS Congress (Cofano F, Di Perna G, Zenga F, Ducati A, Baldassarre B, Ajello M, Marengo N, Ceroni L, Lanotte M, Garbossa D. The Neurology-Stability-Epidural compression assessment: A new score to establish the need for surgery in spinal metastases. Clin Neurol Neurosurg. 2020 Aug;195:105896. Epub 2020 May 19. Erratum in: Clin Neurol Neurosurg. 2021 May 8;205:106673. PMID: 32526620.)


This study was not received any funding.

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Authors and Affiliations



G.D.P. writing, methodology, editing, conceptualization; B.B. editing, analysis; R.D.M., editing, analysis, visualization; D.A., A. Pesa. and A. Pesc. analysis; M.B., S.P., L.B., E.D.L., D.O., C.S., N.M., M.A., F.T., F.Z., M.L., A.Po., A.F., R.A., F.Ce., G.M.B., U.R., editing, data curation and investigation; S.B. data curation; D.G. methodology; F.Co. writing, conceptualization, methodology, supervision and coordination of the study group.

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Correspondence to Raffaele De Marco.

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Di Perna, G., Baldassarre, B., Armocida, D. et al. Application of the NSE score (Neurology-Stability-Epidural compression assessment) to establish the need for surgery in spinal metastases of elderly patients: a multicenter investigation. Eur Spine J (2024).

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