title: Are they too old? Surgical treatment for metastatic epidural spinal cord compression in patients aged 65 years and older.
abstract: OBJECTIVE
  We aimed to assess the efficacy of surgical decompression of metastatic epidural spinal cord compression (MESCC) in patients ≧65 years and review our multidisciplinary surgical decision-making process.
  
  
  METHODS
  We identified all patients operated for MESCC from August 2008 to June 2012. Patients ≧65 years, with a single area of cord compression, back/radicular pain, neurological signs of cord compression, surgery within 48 hours after onset of MESCC-related paraplegia, and follow-up for ≧1 year or until death were included. Files were reviewed retrospectively. The requirement for informed consent was waived. Neurological status was assessed with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Duration of ambulation and survival were assessed with Kaplan-Meier and Cox regression analysis.
  
  
  RESULTS
  Twenty-one patients met inclusion criteria (11 women/10 men; mean age 73 years, range 65-87). All presented with debilitating back/neck pain. Ten patients (48%) were not ambulatory before surgery and four suffered urinary incontinence/constipation (19%). Preoperative AIS was E in 5 patients (24%), D in 11 (62%), and C in 5 (24%). Motor symptoms had been present for a mean of 3·8 days (range 1-14). All patients regained ambulation. Overall, mean survival was 320 days (range 19-798) and mean ambulation was 302 days (range 18-747). On 31 March 2013, 7 patients (33%) were alive and ambulatory at a mean of 459 days (range 302-747); 14 patients had died (67%) at a mean of 251 days (range 19-798), with a mean ambulation of 223 days (range 18-730).
  
  
  CONCLUSIONS
  With careful patient selection, surgery may achieve long duration of ambulation in patients ≧65 years with MESCC.
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
authors.forename: Omer
authors.initials: O
authors.lastname: Or
authors.forename: Leon
authors.initials: L
authors.lastname: Kaplan
authors.forename: Josh
authors.initials: J
authors.lastname: Schroeder
authors.forename: Yair
authors.initials: Y
authors.lastname: Barzilay
authors.forename: Guy
authors.initials: G
authors.lastname: Rosenthal
authors.forename: Yigal
authors.initials: Y
authors.lastname: Shoshan
authors.forename: Shifra
authors.initials: S
authors.lastname: Fraifeld
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000556:secondary*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Age,; Ambulation,; Metastasis,; Metastatic epidural spinal cord compression,; Outcomes,; Spinal surgery; Spine,