title: The timing of surgical intervention in the treatment of complete motor paralysis in patients with spinal metastasis.
abstract: The timing of surgical intervention is important for ambulatory patients with metastatic epidural spinal cord compression (MESCC), while limited studies have focused on non-ambulant patients. The aim of this study was to investigate the proper timing of surgical intervention for paraplegic patients with MESCC.
  
  
  
  Forty-three non-ambulant patients with MESCC who underwent posterior decompression were retrospectively reviewed. The neurological outcomes for pre-operative Frankel B patients with different interval window were further compared.
  
  
  
  Neurologic deficit improved by at least 1 Frankel grade in 37 patients who underwent surgery within 72 h (86.0 %). Overall, 18 pre-operative Frankel B patients became ambulatory again with an interval of less than 48 h, 15 pre-operative Frankel B patients remained non-ambulatory post-operatively with an interval longer than 48 h besides one with an interval of 8 h (P < 0.001). All nine pre-operative Frankel A patients remained non-ambulatory even though the interval window was less than 24 h.
  
  
  
  The timing of surgical intervention was key to predicting the post-operative outcome, and 48 h was suggested as the proper interval window for pre-operative Frankel B patients. These patients preserved sensory function which might be a predictor. And the sooner the surgery was performed, the better the result would be.
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
authors.forename: Xi
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
authors.forename: Hai
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
authors.forename: Pengxiang
authors.initials: P
authors.lastname: Jiang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
authors.forename: Siyi
authors.initials: S
authors.lastname: Cai
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China. liuyongxh@163.com.|, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, People's Republic of China. liuyongxh@163.com.
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013117:Spinal Cord Compression / Q000150:complications / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: Complete motor paralytic; Spinal tumor; Surgical intervention; Timing
references.citation: Eur Spine J. 2013 Jun;22(6):1383-8
references.pmid: 23275041
references.citation: J Neurosurg Spine. 2008 Mar;8(3):279-85
references.pmid: 18312080
references.citation: Acta Neurol Scand. 1996 Oct;94(4):269-75
references.pmid: 8937539
references.citation: Nat Clin Pract Neurol. 2006 Feb;2(2):87-94; quiz 116
references.pmid: 16932530
references.citation: Lancet Neurol. 2008 May;7(5):459-66
references.pmid: 18420159
references.citation: Semin Oncol. 2006 Jun;33(3):307-11
references.pmid: 16769419
references.citation: Br J Cancer. 2006 Feb 27;94(4):486-91
references.pmid: 16434993
references.citation: Paraplegia. 1969 Nov;7(3):179-92
references.pmid: 5360915
references.citation: Gan To Kagaku Ryoho. 2009 Nov;36(12):2342-4
references.pmid: 20037416
references.citation: Eur Spine J. 2007 Oct;16(10):1659-67
references.pmid: 17486376
references.citation: J Bone Joint Surg Br. 2009 Feb;91(2):240-4
references.pmid: 19190061
references.citation: J Neurotrauma. 2011 Mar;28(3):459-67
references.pmid: 21294701
references.citation: Brain. 1995 Feb;118 ( Pt 1):263-78
references.pmid: 7895010
references.citation: Neurosurgery. 2008 Mar;62(3):683-92; discussion 683-92
references.pmid: 18425015
references.citation: Spine (Phila Pa 1976). 2006 Jun 15;31(14):1585-90
references.pmid: 16778693
references.citation: Neuro Oncol. 2005 Jan;7(1):64-76
references.pmid: 15701283
references.citation: Spine (Phila Pa 1976). 2009 Mar 15;34(6):566-71
references.pmid: 19282735
references.citation: Cochrane Database Syst Rev. 2008 Oct 08;(4):CD006716
references.pmid: 18843728
references.citation: Spine (Phila Pa 1976). 2007 Mar 15;32(6):627-34
references.pmid: 17413466
references.citation: Lancet. 2005 Aug 20-26;366(9486):643-8
references.pmid: 16112300