Article
Impact of decompressive laminectomy on the functional outcome of 28 patients with spinal metastases and complete motor paralysis
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Authors
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Alexander Younsi
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Steffen Brenner
- Heidelberg, Deutschland
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Klaus Zweckberger
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Andreas Unterberg
- Universitätsklinikum Heidelberg, Klinik für Neurochirurgie, Neurochirurgie, Heidelberg, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Malignant spinal cord compression (MSCC) is a frequent phenomenon in advanced tumor diseases with varying, but often severe neurological impairments. Decompressive laminectomy is frequently used for surgical treatment of MSCC. Our study aims to analyze the impact of this procedure on the functional outcome of patients with complete motor paralysis.
Methods: A single center retrospective analysis of MSCC-patients with complete motor palsy (Frankel grade A+B) treated with decompressive laminectomy between 2004-2014 was performed. Demographic as well as clinical data were collected from the patients’ hospital records. On imaging, the epidural spinal cord compression scale (ESCC) was calculated. Frankel grade (FG) was used to assess the patients’ functional outcome at discharge, the Spinal instability neoplastic score (SINS) was evaluated to determine spinal stability and the ASA score was documented to define the patients’ overall health. Statistical analysis for possible correlations of various clinical parameters with the patients’ functional outcome was performed.
Results: 28 patients (9 female / 19 male; age 65±11 years) were identified. Lung (39%) and prostate (28%) were the most common primary tumor sites and progressive disease was present in 75% of cases. Paresis was the first symptom in 75% of patients with a median duration of 2 days (IQR 1-6). On admission, 61% of patients had no motor or sensory function below the lesion level (FG A) and the remaining 39% had complete motor paralysis (FG B). Patients were unable to walk for a median duration of 24 hrs. (IQR 24-48). Imaging revealed prevalently cervical or thoracic MSCC (93%) with an ESCC scale of 3 in 75% and a SINS score < 12 in 100% of cases. Emergency surgery (<24 hrs.) was performed in 96% of patients. Median time to surgery was 8 hrs. (IQR 6-13). Median ASA score was 3 and rates of complications and revision surgery were 11% and 4%, respectively. On discharge, FG had improved in 61% of patients and 25% had regained ambulation (FG D+E). Univariate predictors for a favorable outcome (FG D+E) were female sex (p=0.0326) and a higher Karnofsky performance index (KPI) (p=0.0146). Interestingly, shorter duration of symptoms and the exact time of emergency surgery within 24 hrs. after admission showed no significant impact.
Conclusion: Decompressive laminectomy used as an emergency surgical treatment for MSCC with a stable spine has beneficial effects on severely ill cancer patients with complete motor palsy: Ambulation is regained in 25% of cases. A higher KPI prior to surgery (> 30) may be a positive predictor for a favorable outcome.
