Predictor of Postoperative Ambulatory Recovery in Metastatic Spinal Cord Compression with Delayed Surgical Timing and Progressive Paraplegia

Abstract

OBJECTIVETo analyze preoperative predictors of ambulatory recovery after surgical treatment in metastatic spinal cord compression(MSCC) patients with delayed surgical timing and progressive paraplegia. METHODSWe reviewed patients with a preoperative lower-extremity motor grade of ≤ 3 and surgical timing ≥ 48h after the non-ambulatory status. The recovery group(group R) and non-recovery group(group NR) were classified according to ambulation assessment during follow-up. The data on patient demographics, origin of the primary tumor, pre- and postoperative chemotherapy and radiation therapy, surgical procedures, Tokuhashi score, Karnofsky score, preoperative lower-extremity motor grade, and surgical timing were collected for analyzing predictors of postoperative ambulatory recovery. RESULTSOf the 55 patients, 24(43.6%) were group R and 31 patients were group NR. The preoperative motor grade of the lower extremities was the only predictive factor (P<0.05). The mean hip flexor and knee extensor motor grades in group R were 2.0±1.0 and 2.4±1.1 respectively, while in group NR, they were 1.2±1.0 and 1.3±1.0. The odds ratios for failing to regain ambulatory ability were 12.6 in the knee extensor and 4.8 in the hip flexor when the motor grades 0-2 and 3 groups were compared. The rescue ratio of the preoperative hip flexor and knee extensor motor grade 0-2 group were 34.1% and 21.2%, grades 3 group were 71.4% and 77.3%, respectively. CONCLUSIONThe significant predictive factor for ambulatory recovery was the preoperative lower-extremity motor grade. The preoperative knee extensor motor grade was identified as a more important factor than hip flexor motor grade in predicting ambulatory recovery.