Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis.

OBJECTIVE: Spinal involvement in neurocysticercosis is rare and can lead to debilitating injury if not diagnosed and treated early. We aimed to provide the reader with a thorough analysis of the best available evidence regarding patient characteristics, optimal treatment modality and outcomes in cases of spinal neurocysticercosis. Methods A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was made according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An illustrative case of intramedullary cervical spinal disease is also presented for illustrative purposes. RESULTS: A total of 46 reports of 103 patients fitting the screening criteria were identified. Isolated spinal involvement was seen in 46.15% of patients. Most infections (76.92%) had an intradural extramedullary localization with 43.27% of cases involving more than one spinal cord level. The most common presenting symptoms were motor deficits (77.88%), pain syndromes (64.42%), and sensory deficits (53.85%). Combined surgical resection and pharmacologic therapy was the most frequently used treatment modality (49.04%) and had the highest proportion of patients reporting symptomatic improvement at follow up (78.43%). Combination therapy had a significantly higher rate of neurological recovery compared to surgery alone (p=0.004) or medical treatment (p=0.035). CONCLUSIONS: Spinal involvement in neurocysticercosis should be considered in patients from or who traveled to endemic areas presenting with ring enhancing . lesions. Combined treatment with surgery followed by cysticidal and steroid medication appears to be superior to surgery or medical treatment in isolation and seems to provide the highest chances of recovery.