Abstract
Metastatic spinal cord compression (MSCC) is a frequent phenomenon in advanced tumor diseases with often severe neurological impairments. Affected patients are often treated by decompressive laminectomy. To assess the impact of this procedure on Karnofsky Performance Index (KPI) and Frankel Grade (FG) at discharge, a single center retrospective cohort study of neurologically impaired MSCC-patients treated with decompressive laminectomy between 2004 and 2014 was performed. 101 patients (27 female/74 male; age 66.1 ± 11.5 years) were identified. Prostate was the most common primary tumor site (40%) and progressive disease was present in 74%. At admission, 80% of patients were non-ambulatory (FG A–C). Imaging revealed prevalently thoracic MSCC (78%). Emergency surgery (< 24 h) was performed in 71% and rates of complications and revision surgery were 6% and 4%, respectively. At discharge, FG had improved in 61% of cases, and 51% of patients had regained ambulation. Univariate predictors for not regaining the ability to walk were bowl dysfunction (p = 0.0015), KPI < 50% (p = 0.048) and FG < C (p = 0.001) prior to surgery. In conclusion, decompressive laminectomy showed beneficial effects on the functional outcome at discharge. A good neurological status prior to surgery was key predictor for a good functional outcome.
Highlights
Spinal metastases are a common manifestation of malignant diseases and have been reported in autopsy-studies in 30–70% of cancer patients since the 1950s [1,2,3]
In this study of 101 neurologically impaired Metastatic spinal cord compression (MSCC)-patients without spinal instability that received decompressive laminectomy, 74% showed improved motor function and 51% had regained the ability to walk at discharge while overall complication rate as well as revision and mortality rates (6%, 4%, and 1%, respectively) were low
We found that a better neurological status (KPI > 40%, Frankel Grade (FG) > C) prior to surgery is associated with the ability to walk at discharge [34, 35, 70, 71]
Summary
Spinal metastases are a common manifestation of malignant diseases and have been reported in autopsy-studies in 30–70% of cancer patients since the 1950s [1,2,3]. In more than 30% of cases, Despite local back-pain being the initial symptom in most patients, spinal metastases are frequently diagnosed not before neurological deficits occur [9, 11, 12]. Progression of the epidural masses leads to metastatic spinal cord compression (MSCC) and might result in complete and irreversible paraplegia, unless timely treatment is initiated [14] This most serious and devastating sequel of spinal metastases is termed malignant epidural spinal cord compression (MESCC) and occurs in 3–5% of all cancer patients [15, 16]. MESCC does not directly alter life expectancy, its’ severe clinical course results in rapid deterioration of neurological function culminating in a paraplegic status This loss of ambulation leads to a significant reduction of the patients’ quality of life [7, 11]. It is understood that MESCC has to be treated as an oncological emergency, requiring rapid decision-making if neurological
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