Malignant cord compression: A critical appraisal of prognostic factors predicting functional outcome after surgical treatment

Abstract

Objectives:Advanced tumor disease and metastatic spinal cord compression (MSCC) are two entities with a high impact on patients’ quality of life. However, prognostic factors on the outcome after primary decompressive surgery are less well-defined and not yet standardized. The aim of this review was to identify prognostic variables that predict functional or ambulatory outcomes in surgically treated patients with symptomatic MSCC.Materials and Methods:We conducted MEDLINE database searches using relevant keywords in order to identify abstracts referring to prognostic factors on ambulatory outcomes in surgically treated MSCC patients. Details of all selected articles were assembled and the rates of ambulation were stratified.Results:Evidence from five retrospective comparative trials and one observational prospective study summarizes different prognostic factors with a positive or negative influence on postoperative ambulatory status. Ambulatory patients maintaining ambulation status after decompression of the spinal cord constituted 62.1%. The overall rate of MSCC patients losing the ability to ambulate was 7.5% compared to 23.5 % who regained ambulation. Preoperative ambulation status, time to surgery, compression fracture and individual health status seem to be the most relevant prognostic factors for ambulatory outcome.Conclusions:There is a lack of standardized prognostic tools which allow predicting outcome in surgically treated patients. A quantitative score consisting of reliable prognostic tools is essential to predict loss and/or regain of ambulation and requires validation in future prospective clinical trials.

Predictors of 30- and 90-Day Survival Following Surgical Intervention for Spinal Metastases

“…Nonetheless, it seems somewhat intuitive that patients with preserved ambulatory capacity would be able to mobilize to a greater extent following surgery and protect themselves from the development of complications that may contribute to early death, such as pneumonia or pulmonary embolism. 1,14 Our results regarding the influence of primary tumor type on 90-day survival are not surprising. Patients in this analysis with metastatic lung cancer demonstrated a 64% reduction in the odds of survival at 90 days, synonymous with a number of efforts that have shown poor prognosis for patients with this type of cancer.…”

“…[1][2][3][4][5][6][7][8][9][10]13,14,15,19,20 Several studies have indicated that surgery is more advantageous than nonoperative measures in terms of functional outcome, pain control, and preservation of ambulatory capacity. 1,2,8,9 Invariably, not all patients with spinal metastases can benefit from a surgical procedure, especially as such interventions may be physiologically taxing to oncology patients and are known to carry moderately high rates of postoperative morbidity.…”

“…1,9,11 Appreciating the importance of patient selection in ensuring optimal outcomes, a number of studies have attempted to define factors that help identify patients at an elevated risk of mortality in the peri-operative period. 3,5,8,10,[12][13][14] Several authors have proposed scoring systems for the treatment of spinal metastases, 5,8,12,13,15,16 although these often are more appropriately utilized for surgical planning than prognosticating outcome. Most of the available predictive tools 8,12,15,16 have not been validated in independent patient samples and several, including the widely utilized scales by Tokuhashi et al 16 and Tomita et al 15 , were developed before the era of modern spine surgical instrumentation and radiotherapy techniques and were based on small cohorts of patients treated at single centers with limited capacity for generalization.…”

Preoperative Scoring and Limits of Prognostication: Functional Outcome after Surgical Decompression in Metastatic Spinal Cord Compression

“…Additionally, the recommendation for early surgical decompression (<48 h) was supported by two studies [13,25] with a similar distribution of patients regaining ambulation (8-9%). In an inhomogeneous collective of MSCC patients, a mean of 62.1% (range 23-95%) of patients maintained ambulation after surgical treatment [26]. In our study, one third of the patients (35%) representing the most frequent tumors causing MSCC remained ambulatory and half of our patients (51%) were able to ambulate postoperatively.…”

Neoplasm of the spinal cord: Implications for clinical care to improve symptom management and functionality

“…Surgery offers the best potential to maintain ambulation status for patients who were ambulatory before the resection of tumor [22] . It also yields improved Frankel grade classification, a common measure of the completeness of a spinal cord injury, by at least one level postoperatively and decreased pain symptoms [23] .…”