Abstract
BackgroundNeoplastic spinal cord compression is a cause of severe disability in cancer patients. To prevent irreversible paraplegia, a structured strategy is required to address the various impairments present in cancer patients. In this study, we aimed to identify the status where rehabilitation with minimally invasive spine stabilization (MISt) effectively improves ADL.MethodsWe retrospectively reviewed 27 consecutive patients with neoplastic spinal compression who were treated with MISt. We classified the impairments of patients through our multidisciplinary tumor board based on spine-specific factors, skeletal instability, and tumor growth. The neurological deficits, progress of pathological fracture, incidence of vertebral collapse, and postoperative implant failure were examined. Changes of the Barthel index (BI) scores before and after surgery were investigated throughout the clinical courses.ResultsThe average duration to ambulation was 7.19 ± 11 days, and we observed no collapse or progression of paralysis except in four cases of complete motor paraplegia before the surgery. Neurological deficiency was improved to or maintained at Frankel’s grade E in 16 patients, remained unchanged in 6 patients (in grades B, C, D), and worsened in 5 patients. BI score comparisons before and after surgery in all patients showed statistically significant increments (p < 0.05). On further analysis, we noted good functional prognosis in patients capable of ambulation within 7 days (p < 0.05) and in patients who could survive longer than 3 months after the surgery (p < 0.05).ConclusionsIn various cancer patients with neoplastic spinal cord compression, skeletal instability as the primary impairment is a good indication for MISt, as the patients showed early ambulation with improved BI scores.
Highlights
Neoplastic spinal cord compression is a cause of severe disability in cancer patients
According to the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) developed by the World Health Organization, impairment refers to a problem associated with a bodily structure or organ, whereas disability refers to a functional limitation in a particular activity [5]
We retrospectively reviewed the data of 27 consecutive patients with neoplastic spinal compression who were treated with minimally invasive spine stabilization (MISt) and received immediate rehabilitation thereafter
Summary
Neoplastic spinal cord compression is a cause of severe disability in cancer patients. In the US, the 5-year survival rate for all cancers has reached 69.2% for men and 69.1% for women, and these are expected to increase in future years [1]. Cancer patients suffer from a wide range of impairments, partially because of either the disease itself or the adverse effects of treatment. Both physical and psychological impairments contribute to decreased quality of life which may result in disability [5]. Many researchers have demonstrated that cancer rehabilitation improves physical and cognitive impairments, societal participation, and QOL at every stage along the treatment course for a variety of cancer type [7,8,9,10]
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