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Journal of Korean Neurosurgical Society 2011;50(5): 434-440.
doi: https://doi.org/10.3340/jkns.2011.50.5.434
Efficacy of Decompression and Fixation for Metastatic Spinal Cord Compression: Analysis of Factors Prognostic for Survival and Postoperative Ambulation.
Jin Hoon Park, Seung Chul Rhim, Sang Ryong Jeon
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. srjeon@amc.seoul.kr
ABSTRACT
OBJECTIVE
The goals of surgical intervention for metastatic spinal cord compression (MSCC) are prolonging survival and improving quality of life. Non-ambulatory paraplegic patients, either at presentation or after treatment, have a much shorter life expectancy than ambulatory patients. We therefore analyzed prognostic factors for survival and postoperative ambulation in patients surgically treated for MSCC.
METHODS
We assessed 103 patients with surgically treated MSCC who presented with lower extremity weakness between January 2001 and December 2008. Factors prognostic for overall survival (OS) and postoperative ambulation, including surgical method, age, sex, primary tumor site, metastatic spinal site, surgical levels, Tokuhashi score, and treatment with chemo- or radiation therapy, were analyzed retrospectively.
RESULTS
Median OS was significantly longer in the postoperatively ambulatory group [11.0 months; 95% confidence interval (CI), 9.29-12.71 months] than in the non-ambulatory group (5.0 months; 95% CI, 1.80-8.20 months) (p=0.035). When we compared median OS in patients with high (9-11) and low (0-8) Tokuhashi scores, they were significantly longer in the former (15.0 months; 95% CI, 9.29-20.71 months vs. 9.0 months; 95% CI, 7.48-10.52 months; p=0.003). Multivariate logistic regression analysis showed that preoperative ambulation with or without aid [odds ratio (OR) 5.35; 95% CI 1.57-18.17; p=0.007] and hip flexion power greater than grade III (OR 6.23; 95% CI, 1.29-7.35; p=0.038) were prognostic of postoperative ambulation.
CONCLUSION
We found that postoperative ambulation and preoperative high Tokuhashi score were significantly associated with longer patient survival. In addition, preoperative hip flexion power greater than grade III was critical for postoperative ambulation.
Key Words: Spinal metastasis; Survival; Ambulation; Cord compression; Hip flexion; Prognostic factor
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