gms | German Medical Science

Objective: Epidural metastatic cancer in the spine can result in malignant spinal cord compression (MSCC) with neurological symptoms of variable extent. Here we have analyzed our institutional experience with surgical treatment for MSCC in order to characterize its impact on the patients' functional outcomes.

Method: Pertinent data from 308 patients treated in our Department from 1990 through 2011 were collected from the patients' clinical records. The Harrington and Frankel classifications (Frankel grade, FG), the Karnofsky performance index (KPI) as well as the ambulatory status (AS; ambulatory: 1, assistance required: 2, wheelchair: 3, bedridden: 4) were documented. Complications were recorded if the definition of a serious adverse event (SAE) was met. The various clinical parameters were tested for possible correlations with the patients' functional outcomes. Statistical analysis was performed using standard methods.

Results: On admission 56.2% of patients were ambulatory (AS 1 & 2) compared to 73.2% at discharge. 61.9% of patients presenting in AS 3, and 34.3% of cases in AS 4 became ambulatory after surgery (AS 1 & 2).

Univariate predictors of a favourable functional outcome (FG D & E) were age ≤64 yrs. (=median; p=0.037), FG D & E and KPI 70-100 on admission (both p<0.001), single spinal metastasis (p=0.002), non-thoracic location (p=0.009), spinal canal narrowing <30% (p=0.005), spinal instrumentation (p=0.014), surgery <24 hrs. after admission (p<0.001), and no postoperative SAE (p<0.001). Only the FG on admission (D & E vs. A, B & C), the preoperative KPI (≤60 vs. 70-100) and no postoperative SAE were identified as independent predictors (all p<0.001) of a favourable functional outcome in the multivariate regression analysis. Interestingly, outcomes improved significantly over time (FG D & E; 1990-1996: 56.7%, 1997-2003: 63.7%, 2004-2011: 70.6%; p=0.039). This could be correlated to the proportion of cases undergoing surgery <24 hrs. (p=0.022), but not to any of the other parameters linked to the patients' functional outcome.

Conclusions: Surgery for MSCC has a significant beneficial impact on the patients' postoperative functional status, and many patients regain ambulation. A meaningful improvement of functional treatment outcomes seems possible by focusing on early (emergency) surgery. Timely operations will result in less patients presenting in an adverse clinical status, and may generally lead to better functional outcomes.