Clinical course and patient-reported outcomes in conservatively managed spinal cavernous malformations

BACKGROUND: Studies on patients with spinal cavernous malformations (SCM) who were managed conservatively are scarce. We aimed to assess clinical, functional, and patient-reported outcomes in these patients. METHODS: This single-center cohort study included consecutive adult patients with SCM, diagnosed in 1995-2024, who underwent conservative management as the primary treatment strategy and had ≥ 6 months of follow-up. We retrospectively analyzed events of symptomatic hemorrhage (SH) and/or focal neurological deficits (FND) and conducted cross-sectional telephone and questionnaire follow-up. We evaluated functional outcome on the modified Rankin Scale (mRS) and quality of life using EuroQol 5-dimensions 5-levels (EQ-5D-5L) and Patient-Reported Outcome Measurement Information System 29 (PROMIS-29). RESULTS: We identified 30 patients with SCM, of whom 28 were included (median age 47 years [IQR 36-61], 32% women). Nine (32%) initially presented with SH, 10 (36%) with FND, and 9 (32%) incidentally. During a median follow-up of 6.4 years (IQR 4.0-10.6), 10 (36%) patients experienced SH/FND and 5 (18%) underwent surgical intervention. The annual rate of SH/FND was 5.1% (95% CI 2.5-9.4%). At final follow-up, 26 (93%) patients completed the questionnaire and 16 (57%) were functionally independent (mRS ≤ 2). Patients had lower utility-weighted EQ index scores than the general population (0.63 versus 0.87, p < 0.001) and reported more PROMIS-29 anxiety/fear (56.8 versus 50.3, p = 0.002), depression/sadness (55.9 versus 50.3, p = 0.023), and fatigue (55.2 versus 49.4, p = 0.029). CONCLUSIONS: Among 28 conservatively managed patients with SCM, 23 (82%) did not require surgical treatment during follow-up and the majority remained functionally independent. However, patients do report worse health than the general population, particularly mental health.