title: Neurological Recovery after Posterior Spinal Surgery in Patients with Metastatic Epidural Spinal Cord Compression.
abstract: Metastatic epidural spinal cord compression (MESCC) is a common complication in patients with a malignant tumor, but it is difficult to decide the proper time to perform the necessary surgery. Here we analyzed the prognostic factors for postoperative walking ability. We retrospectively reviewed the cases of 112 MESCC patients treated surgically at our institute and divided them into ambulatory (n＝ 88) and non-ambulatory (n＝24) groups based on their American Spinal Injury Association (ASIA) Impairment Scale grades at the final follow-up. We also classified the patients preoperatively using the revised Tokuhashi score. We assessed the correlation between preoperative or intraoperative factors and postoperative walking ability in both groups. Of the 10 patients classified preoperatively as grade A or B, 2 (20% ) were ambulatory at the final follow-up. Of the 102 patients classified preoperatively as grade C, D or E, 86 (84% ) were ambulatory at the final follow-up (p＜0.001). There were no significant differences between the groups in the average total Tokuhashi score. Our analysis revealed that the severity of paralysis significantly affects neurological recovery in patients with MESCC. Patients with MESCC should receive surgery before the preoperative ASIA Impairment Scale grade falls below grade C.
authors.affiliation: Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Watanabe
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sugimoto
authors.forename: Masato
authors.initials: M
authors.lastname: Tanaka
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Mazaki
authors.forename: Shinya
authors.initials: S
authors.lastname: Arataki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takigawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Kataoka
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kunisada
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Ozaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000556:secondary*; D016896:Treatment Outcome; D055815:Young Adult