Objective: To determine whether preoperative parameters correlate with the postoperative functional outcome in para- and tetraplegic patients with lung, kidney, breast and prostate cancer and metastatic spinal cord compression (MSCC). Methods: Information on 43 patients undergoing decompressive surgery and rehabilitation for MSCC was reviewed, including primary tumor, age, pre- and postoperative ambulation status, mobility subcategory of the Spinal Cord Injury Measure (mSCIM) and the Tokuhashi score. Differences between groups were analyzed by the nonparametric χ2 test, and correlation coefficients (Spearman's rho) were computed. Results: Preoperative ambulation (p < 0.001), the American Spinal Injury Association Impairment Scale (p < 0.001) and the type of operation (p = 0.02) influenced the postoperative functional outcome. Any positive change in the mSCIM was influenced by preoperative ambulation (p < 0.001). Patients with breast carcinoma showed significantly more positive changes in the mSCIM compared with other tumors (p = 0.002). No correlation was found between the treatment categories of the Tokuhashi score and the preoperative ambulatory status (p = 0.13) or the change in ambulation status (p = 0.29). Conclusion: The postoperative functional outcome of MSCC patients shows a linear association between the categories of the Tokuhashi score and the change in ambulation status. We recommend surgical decompression even in a palliative situation (Tokuhashi score 0-8) with the aim of optimizing the short-term rehabilitation outcome. © 2014 S. Karger AG, Basel

Keywords:
Metastatic spinal cord compression, Malignant cord compression, Clinical trial, Malignancy, Prognosis, Surgery
1.
Tokuhashi Y, Oda H, Oshima M, et al: A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 2005;30:2186-2191.
2.
Chaichana KL, Pendleton C, Sciubba DM, et al: Outcome following decompressive surgery for different histological types of metastatic tumors causing epidural spinal cord compression. Clinical article. J Neurosurg Spine 2009;11:56-63.
3.
Akbar M, Ayache A, Eichler M, Klotz M, Wiedenhöfer B, Lehner B: Management of spinal metastases, strategies and surgical indications (in German). Orthopade 2012;41:632-639.
4.
Gunzburg R, Szpalski M, Aebi M: Vertebral Tumors. Philadelphia, Pa., Lippincott Williams & Wilkins, 2008, Chapter 2: Classifications of bone tumors of the spine, pp 11-22.
5.
Fattal C, Gault D, Leblond C: Metastatic paraplegia: care management characteristics within a rehabilitation center. Spinal Cord 2009;47:115-121.
6.
Chaichana KL, Woodworth GF, Sciubba DM, et al: Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression. Neurosurgery 2008;62:683-692.
7.
Hirabayashi H, Ebara S, Kinoshita T, et al: Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer 2003;97:476-484.
8.
Weigel B, Maghsudi M, Neumann C, et al: Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine 1999;24:2240-2246.
9.
Tokuhashi Y, Matsuzaki H, Toriyama S, et al: Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 1990;15:1110-1113.
10.
Karnofsky DA: Clinical evaluation of anticancer drugs: cancer chemotherapy. GANN Monogr 1967;22:223-231.
11.
Harrington KD: Orthopaedic surgical management of skeletal complications of malignancy. Cancer 1997;80:1614-1627.
12.
Catz A, Itzkovich M: Spinal Cord Independence Measure: comprehensive ability rating scale for the spinal cord lesion patient. J Rehabil Res Dev 2007;44:65-68.
13.
Fürstenberg CH, Wiedenhöfer B, Gerner HJ, Putz C: The effect of early surgical treatment on recovery in patients with metastatic compression of the spinal cord. J Bone Joint Surg Br 2009;91:240-244.
14.
Marino RJ, et al: International Standards for Neurological and Functional Classification of Spinal Cord Injury. Chicago, American Spinal Injury Association, 2000.
15.
McLinton A, Hutchison C: Malignant spinal cord compression: a retrospective audit of clinical practice at a UK regional cancer centre. Br J Cancer 2006;94:486-491.
16.
Held JL, Peahota A: Nursing care of the patient with spinal cord compression. Oncol Nurs Forum 1993;20:1507-1514.
17.
Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, et al: Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005;366:643-648.
18.
Chi JH, Gokaslan Z, Chi JH, Gokaslan Z, et al: Selecting treatment for patients with malignant epidural spinal cord compression - does age matter? Results from a randomized clinical trial. Spine 2009;34:431-435.
19.
Tang V, Harvey D, Park Dorsay J, et al: Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning. Spinal Cord 2007;45:671-677.
20.
Moon KY, Chung CK, Jahng TA, et al: Postoperative survival and ambulatory outcome in metastatic spinal tumors: prognostic factor analysis. J Korean Neurosurg Soc 2011;50:216-223.
21.
Nurick S: The pathogenesis of spinal cord disorder associated with cervical spondylosis. Brain 1972;95:87-100.
22.
McKinley WO, Conti-Wyneken AR, Vokac CW, Cifu DX: Rehabilitative functional outcome of patients with neoplastic spinal cord compressions. Arch Phys Med Rehabil 1996;77:892-895.
23.
Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD: Performance profiles of the functional independence measure. Am J Phys Med Rehabil 1993;72:84-89.
24.
Anderson K, Aito S, Atkins M, et al; Functional Recovery Outcome Measures Work Group: Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med 2008;31:133-144.
25.
Putz C, Wiedenhöfer B, Gerner HJ, Fürstenberg CH: Tokuhashi prognosis score: an important tool in prediction of the neurological outcome in metastatic spinal cord compression: a retrospective clinical study. Spine 2008;33:2669-2674.
26.
Putz C, van Middendorp JJ, Pouw MH, et al: Malignant cord compression: a critical appraisal of prognostic factors predicting functional outcomes after surgical treatment. J Craniovertebr Junction Spine 2010;1:67-73.
27.
Quraishi NA, Giannoulis KE, Manoharan SR, Edwards KL, Boszczyk BM: Surgical treatment of cauda equina compression as a result of metastatic tumours of the lumbo-sacral junction and sacrum. Eur Spine J 2013;22(suppl 1):S33-S37.
28.
Putz C, Fürstenberg CH, Gerner HJ, Wiedenhöfer B: Re: Chi JH, Gokaslan Z, Chi JH, Gokaslan Z, et al. Selecting treatment for patients with malignant epidural spinal cord compression - does age matter? Results from a randomized clinical trial. Spine 2009;34:431-435. Spine (Phila Pa 1976) 2009;34:1884-1885.
© 2014 S. Karger AG, Basel
2014
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