Article
Primary cancer determines the extent of impairment as well as surgical treatment for metastatic spinal cord compression without affecting the patients' functional outcome
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Authors
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Sami Ridwan
- Evangelisches Krankenhaus Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Alexander Grote
- Evangelisches Krankenhaus Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Konstantinos Gousias
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Abteilung BG Neurochirurgie und Neurotraumatologie, Bochum, Deutschland
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Matthias Simon
- Evangelisches Krankenhaus Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Epidural metastatic cancer in 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 the impact of primary cancer on surgical management and the patients’ functional outcomes.
Methods: Pertinent data from 209 patients treated in our Department from 2001 through 2011 were collected from the patients’ clinical records. Primary cancer site, the neurological status (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. Surgical, neurological and systemic complications were recorded. The various clinical parameters were tested for possible correlations with the patients’ functional outcomes. Statistical analysis was performed using standard methods.
Results: Primary cancer site was lung in 23.4%, prostate 18.7%, breast 17.7% and other in 40.2%. On admission 55% of patients were ambulatory (AS 1 & 2) compared to 72.2% at discharge. 60.4% of patients presenting with AS 3, and 32.5% of cases in AS 4 became ambulatory after surgery (AS 1 & 2). Extracting patients with lung, breast and prostate cancer, significant differences in clinical presentation were found. Primary site was majorly untreated in lung cancer (p<0.0001). Prostate showed less pathological fracture (p=0.024). Whereas paravertebral growth was higher in lung (p=0.009). Breast patients presented with better Frankel grades (p=0.043). Interestingly axial pain was less in prostate patients (p=0.004) as well as using internal fixation as surgical strategy (p=0.007). Lung patients suffered more severe adverse events (p=0.016). Primary cancer had no impact on the functional outcome at discharge.
Conclusion: Surgery for MSCC has a significant beneficial impact on the patients’ postoperative functional status, and many patients regain ambulation. Primary cancer site determines clinical presentation and surgical strategies but doesn’t affect the functional outcome on discharge.
