Article
The effect of emergency spinal cord decompression on early outcome in patients with metastatic epidural spinal cord compression (MESCC)
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Authors
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Christian T. Ulrich
- Klinik und Poliklinik für Neurochirurgie, Goethe Universität, Frankfurt am Main, Deutschland
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Lutz M. Weise
- Klinik und Poliklinik für Neurochirurgie, Goethe Universität, Frankfurt am Main, Deutschland
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Gerhard Marquardt
- Klinik und Poliklinik für Neurochirurgie, Goethe Universität, Frankfurt am Main, Deutschland
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Volker Seifert
- Klinik und Poliklinik für Neurochirurgie, Goethe Universität, Frankfurt am Main, Deutschland
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Matthias Setzer
- Klinik und Poliklinik für Neurochirurgie, Goethe Universität, Frankfurt am Main, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: In the setting of MESCC laminectomy alone compared with radiation therapy has no additional benefit. Therefore, more aggressive circumferential decompression and complex spine reconstructions have been proposed. These surgeries are time consuming and can usually not be done in an emergency setting, due to the emergency setting of MESCC. Although, the optimal time point for surgical intervention is discussed controversially. The aim of this study was to evaluate the effect of an emergency spinal cord decompression on the early outcome in a historical collective of patients with MESCC.
Methods: The charts of 87 consecutive patients (26 women, 65 men; mean age 63.5 years±10,8) with MESCC who underwent an emergency SCD between February 2003 and January 2010 were reviewed retrospectively. Variables evaluated were: time between onset of neurological deficits to surgical decompression, the pre- and early postoperative ASIA scores, and the early ability to ambulate. Variables were analysed with univariate and multivariate methods. A backward stepwise binary logistic regression analysis was performed to determine the effect of the evaluated variables in a multivariate model.
Results: Of the 87 patients with MESCC the ASIA score improved immediately after surgery in 40 patients (45,9%) in 46 (54,1%) it did not. The ability to walk immediately after surgery improved in 35 patients (40,2%), whereas in 52 (59,8%) it did not improve. Mean time between onset of neurological deficits and surgical decompression was 4,8 d±7,2. In a multivariate model the time between onset of neurological deficits and surgical decompression was a significant independent predictor for non-improvement of the ability to walk after surgical spinal cord decompression (p<0,05; OR 1,2 95% CI 1,0–1,4). The preoperative ASIA score was a significant independent predictor for the ability to walk immediately after surgery (p<0,05; OR 3,8 95% CI 2,0–7,1).
Conclusions: The results emphasize the importance of an urgent decompression in patients with MESCC. If surgical intervention is indicated patients with MESCC should undergo spinal cord decompression as soon as possible preserving the ability to walk. In patients with a rapid deterioration of the neurological status staging of the surgical intervention with an emergency posterior spinal cord decompression and a subsequent circumferential spinal cord decompression with spine reconstruction in an elective second setting seems to be an alternative.
