gms | German Medical Science

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 the surgical treatment of MSCC. Our study aims to analyze the impact of this procedure on the patients’ functional outcome.

Method: A single center retrospective analysis of MSCC-patients treated with decompressive laminectomy between 2004-2014 was performed. Demographic as well as clinical data were collected from the patients’ hospital records. Epidural Spinal Cord Compression (ESCC) scale and Tokuhashi score were calculated. To assess the patients’ functional outcome, the Karnofsky performance index (KPI), Eastern Cooperative Oncology Group (ECOG) performance status and Frankel grade (FG) were documented. Statistical analysis for possible correlations between the various clinical parameters with the patients’ functional outcome was performed.

Results: 139 patients (39 female / 100 male; age 64 ± 12 years) were identified. Prostate (35.3%) and lung (19.4%) were the most common primary tumor sites. Progressive disease was present in 71.2% of cases and paresis was the first symptom in half of the patients. On admission, KPI was <70% in 80.6% of cases and 59.7% of patients were non-ambulatory (FG A-C). Imaging revealed chiefly thoracic MSCC (76.1%) with a high ESCC scale (2-3) in 91.2%. Emergency surgery (<24 hrs) was performed in one third of the patients. Rates of complications and revision surgery were 8.6% and 5.8% respectively. On discharge, FG had improved in nearly half of the patients and only one third remained non-ambulatory (FG D+E). An ECOG status of 2 or higher was present in 79.1% of cases. Univariate predictors for a favorable outcome (FG D+E) were a high Tokuhashi score (p=0.0021), pain as the first symptom (p=0.001), KPI >70% as well as ECOG status <3 and FG >C on admission (p<0.0001 each). Interestingly, the location of the MSCC, ESCC scale and emergency surgery showed no significant impact.

Conclusions: Decompressive laminectomy as surgical treatment for MSCC has a high beneficial impact on the patients’ functional status at discharge: FG is improved in nearly every second patient and many regain the ability to walk. A good neurological status prior to surgery (FG >C, ECOG <3, KPI >70%) remains the key predictor for a favorable outcome. Interestingly, the prognostic Tokuhashi score may also serve as an indicator for better functional outcome after surgery.