Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression.
OBJECTIVE
Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. This study was designed to explore associations with maintaining and regaining ambulatory function after decompressive surgery for MESCC.


METHODS
Seventy-eight patients undergoing decompressive surgery for MESCC at an academic tertiary care institution between 1995 and 2005 were retrospectively reviewed. Fisher's exact analysis was used to compare preoperative ambulatory and nonambulatory patients. Multivariate Cox proportional hazards regression was used to identify associations with either maintaining or regaining the ability to walk.


RESULTS
Patients were followed for 7.1 +/- 1.6 (mean +/- standard deviation) months after surgery. Preoperative nonambulatory patients required more extensive surgery (increased operative spinal levels and number of laminectomies) and had more surgical site complications (wound dehiscences and cerebrospinal fluid leaks) compared with preoperative ambulatory patients. From the multivariate analysis, preoperative ability to walk (relative risk [RR], 2.320; 95% confidence interval [CI], 1.301-4.416; P < 0.01) independently increased the likelihood of ambulation at the last follow-up evaluation 2.3-fold. Pathological vertebral compression fracture at presentation (RR, 0.471; 95% CI, 0.235-0.864; P = 0.01) independently decreased the likelihood of ambulation at the time of the last follow-up evaluation 2.1-fold. For patients unable to walk at the time of surgery, preoperative radiation therapy (RR, 0.406; 95% CI, 0.124-0.927; P = 0.03) decreased the likelihood of regaining the ability to walk 2.5-fold. Symptoms present for less than 48 hours (RR, 2.925; 95% CI, 1.133-2.925; P = 0.02) and postoperative radiotherapy (RR, 2.595; 95% CI, 1.039-8.796; P = 0.04) independently increased the likelihood of regaining ambulatory ability 2.9- and 2.6-fold, respectively, by the time of last follow-up evaluation.


CONCLUSIONS
The identification of these associations with neurological outcome may help guide in the preservation or return of ambulation after surgery for patients with MESCC.
Chaichana
Kaisorn L
KL
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. kaisorn@jhmi.edu
Woodworth
Graeme F
GF
Sciubba
Daniel M
DM
McGirt
Matthew J
MJ
Witham
Timothy J
TJ
Bydon
Ali
A
Wolinsky
Jean Paul
JP
Gokaslan
Ziya
Z
D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D020127:Recovery of Function; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome