title: Predictors of ambulatory function after surgical resection of intramedullary spinal cord tumors.
abstract: BACKGROUND
  Contemporary treatment of intramedullary spinal cord tumors (IMSCTs) involves radical or subtotal tumor resection with adjuvant radiation and/or chemotherapy, depending on the tumor's histological type and grade as well as the extent of resection. Despite advances in surgical therapy, this approach continues to have significant morbidity. Although previous research is limited, identifying reliable predictors of functional status after tumor resection would be clinically useful for perioperative modification strategies.
  
  
  METHODS
  All patients who underwent surgery for IMSCTs at an academic tertiary care institution between 1995 and 2004 were retrospectively reviewed, and predictors of postoperative neurological functional status were assessed by multivariate logistical regression analysis. Neurological status was gauged by the ability to walk without assistance at the time of the last follow-up visit.
  
  
  RESULTS
  Seventy-eight IMSCT resections were performed during the study period. Preoperative (on the day of or the day before surgery) serum glucose greater than 170 mg/dl (relative risk, 0.03; 95% confidence interval, 0.00-0.27; P = 0.001) and preoperative radiation therapy (relative risk, 0.02; 95% confidence interval, 0.00-0.39, P = 0.012) were independently associated with poor functional status postoperatively. The ability to walk unassisted before surgery (relative risk, 17.1; 95% confidence interval, 1.89-154.5, P = 0.012), on other hand, was the only positive predictor of the ability to walk unassisted at the time of the last follow-up visit.
  
  
  CONCLUSIONS
  This study suggests that early surgical intervention after the onset of symptoms for patients with IMSCT may help preserve ambulatory function. Deferral of preoperative radiation therapy for less radiosensitive tumors and strict perioperative glucose control may also help maximize a patient's subsequent ambulatory status.
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. gw@jhmi.edu
authors.forename: Graeme F
authors.initials: GF
authors.lastname: Woodworth
authors.forename: Kaisorn L
authors.initials: KL
authors.lastname: Chaichana
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gokaslan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
mesh_terms: D000328:Adult; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome