title: Malignant cord compression: A critical appraisal of prognostic factors predicting functional outcome after surgical treatment.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Spinal Cord Injury Center, Heidelberg University Hospital, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Putz
authors.forename: Joost J
authors.initials: JJ
authors.lastname: van Middendorp
authors.forename: Martin H
authors.initials: MH
authors.lastname: Pouw
authors.forename: Babak
authors.initials: B
authors.lastname: Moradi
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Rupp
authors.forename: Norbert
authors.initials: N
authors.lastname: Weidner
authors.forename: Carl Hans
authors.initials: CH
authors.lastname: Fürstenberg