title: Preoperative prediction for regaining ambulatory ability in paretic non-ambulatory patients with metastatic spinal cord compression.
abstract: METHODS
  Retrospective multicenter study.
  
  
  OBJECTIVE
  To analyze the predictive factors for postoperative ambulatory recovery in paretic non-ambulatory patients with metastatic spinal cord compression (MSCC).
  
  
  METHODS
  Japan.
  
  
  METHODS
  Eighty-two consecutive patients (74.4% men; mean age, 66.2 years) who could not walk before surgery due to cervical or thoracic MSCC and underwent posterior decompressive surgery between 2003 and 2014 were included. Patients were divided into two groups according to ambulatory status at 6 weeks after surgery: recovery (group R) and non-recovery (group NR). To evaluate the speed of progression of motor deficits, we assessed the period from onset of neurological symptoms to gait inability (T1).
  
  
  RESULTS
  Fifty patients (61.0%) regained the ability to walk (group R). The period of T1 demonstrated a positive correlation with probability of ambulatory recovery (P=0.00; Kendall's tau-b=0.38), and a receiver operating characteristic curve analysis showed that the cutoff value of T1 was 5 days (area under the curve=0.72; P=0.001). In multivariate analysis, <6 days of T1 was one of the independent risk factors for failing to regain ambulatory ability (odds ratio, 8.74; P=0.00).
  
  
  CONCLUSIONS
  The speed of progression of motor deficits can independently and powerfully predict the chance of postoperative ambulatory recovery as well as previously identified predictors. Since information about the speed of progression can be obtained easily by interviewing patients or family members, even if the patient is in an urgent state, our results will be helpful in clinical decision-making.
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ohashi
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hirano
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Katsumi
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Shoji
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, Shibata, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Sano
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Joetsu, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tashi
authors.affiliation: Department of Orthopedic Surgery, Niigata City General Hospital, Niigata, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Takahashi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Joetsu, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Wakasugi
authors.affiliation: Department of Orthopedic Surgery, Tsuruoka Municipal Hospital, Tsuruoka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Shibuya
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D016138:Walking / Q000502:physiology*