Early Neurological Deterioration and Longitudinal Recovery After Spinal Ependymoma Surgery: A Multidimensional Outcome Analysis

Objective : To characterize longitudinal neurological and functional outcomes after spinal ependymoma surgery and explore factors associated with early postoperative deterioration. Methods : A retrospective cohort study was conducted including adult patients who underwent surgical resection of a histologically confirmed spinal ependymoma between 2018 and 2024. Neurological and functional status was assessed using the American Spinal Injury Association Impairment Scale (AIS), Modified McCormick Scale (MMS), modified Rankin Scale (mRS), and ambulatory status at baseline, discharge, and 3, 6, and 12 months. The primary endpoint was deterioration in at least one measure at discharge relative to baseline. Longitudinal analyses evaluated postoperative trajectories, while multivariable logistic regression was used to explore factors associated with deterioration at discharge. Results : Fifty-five patients were included. Composite deterioration at discharge occurred in 23 patients (41.8%). Outcomes varied across timepoints (Friedman test, all p<0.001), with early worsening followed by recovery predominantly within 6 months. At 12 months, 15 patients (27.3%) remained worse than baseline in at least one measure; all had deteriorated at discharge, whereas none without discharge deterioration developed new late worsening (p<0.001). In exploratory multivariable analysis, cervical (OR, 7.06; p=0.017) and thoracic location (OR, 5.27; p=0.043) were associated with composite deterioration compared with lumbosacral location. Greater tumor extension was associated with MMS and mRS deterioration. Conclusion : Postoperative deterioration was common, although cohort-level outcomes generally improved during the first 6 months. Persistent 12-month deficits occurred exclusively among patients who had deteriorated at discharge. Multidimensional longitudinal assessment may support postoperative counseling and targeted follow-up.