title: Preoperative scoring and limits of prognostication: functional outcome after surgical decompression in metastatic spinal cord compression.
abstract: OBJECTIVE
  To determine whether preoperative parameters correlate with the postoperative functional outcome in para- and tetraplegic patients with lung, kidney, breast and prostate cancer and metastatic spinal cord compression (MSCC).
  
  
  METHODS
  Information on 43 patients undergoing decompressive surgery and rehabilitation for MSCC was reviewed, including primary tumor, age, pre- and postoperative ambulation status, mobility subcategory of the Spinal Cord Injury Measure (mSCIM) and the Tokuhashi score. Differences between groups were analyzed by the nonparametric χ(2) test, and correlation coefficients (Spearman's rho) were computed.
  
  
  RESULTS
  Preoperative ambulation (p < 0.001), the American Spinal Injury Association Impairment Scale (p < 0.001) and the type of operation (p = 0.02) influenced the postoperative functional outcome. Any positive change in the mSCIM was influenced by preoperative ambulation (p < 0.001). Patients with breast carcinoma showed significantly more positive changes in the mSCIM compared with other tumors (p = 0.002). No correlation was found between the treatment categories of the Tokuhashi score and the preoperative ambulatory status (p = 0.13) or the change in ambulation status (p = 0.29).
  
  
  CONCLUSIONS
  The postoperative functional outcome of MSCC patients shows a linear association between the categories of the Tokuhashi score and the change in ambulation status. We recommend surgical decompression even in a palliative situation (Tokuhashi score 0-8) with the aim of optimizing the short-term rehabilitation outcome.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Putz
authors.forename: S
authors.initials: S
authors.lastname: Gantz
authors.forename: T
authors.initials: T
authors.lastname: Bruckner
authors.forename: B
authors.initials: B
authors.lastname: Moradi
authors.forename: L
authors.initials: L
authors.lastname: Helbig
authors.forename: H J
authors.initials: HJ
authors.lastname: Gerner
authors.forename: N
authors.initials: N
authors.lastname: Weidner
authors.forename: R
authors.initials: R
authors.lastname: Rupp
authors.forename: M
authors.initials: M
authors.lastname: Akbar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology*; D011184:Postoperative Period; D011379:Prognosis; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology*; D020127:Recovery of Function; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary*; D016896:Treatment Outcome