Objective

Metastatic spinal cord compression (MSCC) is a frequent phenomenon in cancer disease, often leading to severe neurological deficits. Especially in patients with complete motor paralysis, regaining the ability to walk is an important treatment goal. Our study, therefore, aimed to assess the neurological outcome of patients with MSCC and complete motor paralysis after decompressive surgery.

Methods

Patients with MSCC and complete motor paralysis, surgically treated by decompressive surgery between 2004–2014 at a single institution were retrospectively analyzed. Clinical patient data were collected from medical records. To assess the neurological outcome, Frankel grade (FG) at admission and discharge were compared. Statistical analysis was performed to identify factors associated with an ambulatory status after surgery.

Results

Twenty-eight patients were included in this study. The majority of metastases (57 %) were located in the thoracic spine and 75 % showed extraspinal tumor spread. The median interval between loss of ambulation and surgery was 35 h (IQR: 29–70). Posterior circumferential decompression without stabilization was performed in all cases within 24 h of admission. Neurological function improved in 17 patients (63 %) and seven (26 %) even regained the ability to walk following surgery. The rate of complications was low (7%). In statistical analysis, only the Karnofsky Performance Index (KPI) displayed a significant predictive value for an ambulatory status at discharge.

Conclusions

Our findings indicate that severely affected MSCC patients with complete motor paralysis might benefit from decompressive surgery even when the loss of ambulation occurred more than 24 h ago.

中文翻译：

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转移性脊髓受压所致瘫痪抢救性减压手术的可行性

客观的

转移性脊髓压迫 (MSCC) 是癌症疾病中的常见现象，通常会导致严重的神经功能缺损。尤其是在完全运动麻痹的患者中，恢复行走能力是一个重要的治疗目标。因此，我们的研究旨在评估减压手术后 MSCC 和完全运动麻痹患者的神经系统预后。

方法

回顾性分析了 2004 年至 2014 年间在单一机构接受减压手术治疗的 MSCC 和完全运动麻痹患者。从医疗记录中收集临床患者数据。为了评估神经系统结果，比较了入院和出院时的 Frankel 分级 (FG)。进行统计分析以确定与手术后走动状态相关的因素。

结果

28 名患者被纳入本研究。大多数转移灶（57%）位于胸椎，75% 的转移灶表现为脊柱外肿瘤扩散。不能行走和手术之间的中位间隔为 35 小时（IQR：29-70）。所有病例均在入院后 24 小时内进行无稳定的后环减压。17 名患者 (63 %) 的神经功能得到改善，7 名 (26 %) 甚至在手术后恢复了行走能力。并发症发生率低（7%）。在统计分析中，只有卡诺夫斯基表现指数 (KPI) 显示出院时走动状态的显着预测值。

结论

我们的研究结果表明，即使在 24 小时前失去行走能力，患有完全运动麻痹的严重影响的 MSCC 患者也可能从减压手术中受益。