Primary Intradural Extramedullary Spinal Tumors in the Elderly: Beyond Chronological Age

Abstract Purpose To determine whether chronological age influences functional outcome after surgery for primary intradural extramedullary (IDEM) spinal tumors, and which preoperative factors predict an unfavorable result. Methods Retrospective single-center study of 103 consecutive patients operated on for an IDEM tumor (2016–2025). The primary outcome was functional independence (modified Rankin Scale, mRS 0–2) at last follow-up. Patients aged 70 years or older (n = 26) were compared with younger patients (n = 77), and seven prespecified factors were tested by univariable Firth penalized logistic regression for an unfavorable outcome (mRS 3–5). Results Median age was 58 years; schwannoma (51.5%) and meningioma (45.6%) predominated. Complete excision was achieved in 82.5% and complications occurred in 10.7%; all 6 recurrences (6.0%) followed partial excision. Over a median follow-up of 24 months, independence rose from 68.9% to 89.1%. Elderly patients presented with worse baseline status (mRS 3–5: 57.7% vs. 22.1%, p = 0.001) and more meningiomas (80.8% vs. 33.8%, p < 0.001), yet achieved equivalent complete excision (76.9% vs. 84.4%, p = 0.384), complication (7.7% vs. 11.7%, p = 0.726) and independence rates (88.0% vs. 89.5%, p = 1.000). No deaths occurred. Only the mRS at diagnosis (OR 3.58 per point, 95% CI 2.02–7.40) and myelomalacia (OR 4.86, 95% CI 1.28–26.52) were associated with an unfavorable outcome; age 70 years or older was not (OR 1.25, 95% CI 0.29–4.48). Conclusions Chronological age alone should not preclude surgery for IDEM tumors. Baseline function and preoperative cord signal change, not age, set the ceiling of recovery.