Predictors of Postoperative Gain in Ambulatory Function After Decompressive Surgery for Metastatic Spinal Cord Compression

Hideyuki Kinoshita; Hiroto Kamoda; Yoko Hagiwara; Seiko Kinoshita; Seiji Ohtori; Tsukasa Yonemoto

doi:10.21873/anticanres.16330

Predictors of Postoperative Gain in Ambulatory Function After Decompressive Surgery for Metastatic Spinal Cord Compression

Anticancer Res. 2023 Apr;43(4):1767-1773. doi: 10.21873/anticanres.16330.

Authors

Hideyuki Kinoshita¹, Hiroto Kamoda², Yoko Hagiwara², Seiko Kinoshita³, Seiji Ohtori⁴, Tsukasa Yonemoto²

Affiliations

¹ Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan; kinoshi1783@yahoo.co.jp.
² Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan.
³ Laboratory of Oncogenomics, Chiba Cancer Center Research Institute, Chiba, Japan.
⁴ Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

PMID: 36974815
DOI: 10.21873/anticanres.16330

Abstract

Background/aim: Reports on the effects of timing of the surgery on the patient survival rate or the results of palliative laminectomy are limited. The aim of the study was to investigate the postoperative ambulatory status of neurologically impaired metastatic spinal cord compression (MSCC) patients who underwent laminectomy and evaluate predictors of postoperative ambulation recovery after laminectomy for MSCC.

Patients and methods: We included 175 patients who underwent decompressive surgery for MSCC. Changes in the Frankel grade (FG) were evaluated perioperatively. Among all patients, 113 were unable to walk preoperatively and were divided into two groups: 70 and 43 patients in the ambulation-regained and ambulation-not regained postoperatively groups, respectively. The percentage of patients eligible for postoperative chemotherapy and overall survival rate in each group were investigated. Furthermore, predictors of postoperative ambulation recovery after laminectomy for MSCC were examined.

Results: The most common primary tumor sites were the lung, prostate, and breast. FG improved with surgery in 80 cases, remained unchanged in 94 cases, and worsened in one case. In the ambulation-regained group, 70% were eligible for postoperative chemotherapy, while only 26% of the not-regained group were eligible for postoperative chemotherapy. The postoperative survival rate of the ambulation-regained group was significantly better than that of the not-regained group. Univariate predictors for not regaining the ability to walk were Karnofsky Performance Status ≤40 prior to surgery, FG B prior to surgery, and time to surgery since the inability to walk >48 h.

Conclusion: Decompressive surgery benefits motor function postoperatively. Both good neurological status prior to surgery and prompt surgery for non-ambulatory MSCC are important predictors of improved functional outcome.

Keywords: Metastatic spinal cord compression (MSCC); ambulation recovery; decompressive surgery; survival rate.

MeSH terms

Humans
Karnofsky Performance Status
Male
Retrospective Studies
Spinal Cord Compression* / etiology
Spinal Cord Compression* / surgery
Spinal Neoplasms* / secondary
Spinal Neoplasms* / surgery
Treatment Outcome
Walking