Artikel
Surgical treatment for metastatic spinal cord compression in the elderly – a single center experience
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Autoren
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Sami Ridwan
- Evangelisches Klinikum Bethel, Neurochirurgie, Bielefeld, Deutschland; Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Alexander Grote
- Evangelisches Klinikum Bethel, Neurochirurgie, Bielefeld, Deutschland; Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Matthias Simon
- Evangelisches Klinikum Bethel, Neurochirurgie, Bielefeld, Deutschland; Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Surgery in patients with malignant spinal cord compression (MSCC) has been shown to be safe and beneficial. Here we have analyzed our experience with surgical treatment for MSCC in elderly patients.
Methods: Pertinent data from all 209 MSCC patients treated in our Department during a 10-year period were collected from the hospital's database, including 107 elderly patients ≥65 yrs. (36 ≥75 yrs.). Primary cancer site, Frankel grade (FG) and Karnofsky performance index (KPI) on admission and after surgery 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 in elderly patients was prostate in 25.2%, lung in 24.3%, breast in 11.2% and other in 39.3% (younger patients: breast 24%, lung 22.1%, prostate 11.5%, other 42.3%). Elderly patients presented with multiple metastases and radicular pain more often (p=0.007 & 0.004). There were no differences regarding tumour location, surgical approaches and emergency surgery between the two groups, however spinal instrumentation was performed more often in younger patients (p=0.034). On admission 48.6% of patients ≥65 yrs. were ambulatory (FG D&E, younger patients: 53.8%) compared to 63.4% (younger patients: 74%) at discharge. 35.6% of elderly patients (younger patients: 51.3%, patients ≥75yrs.: 29.4%) presenting with FG C became ambulatory after surgery (FG D&E). Elderly patients showed lower improvement rates in terms of KPI (p=0.023). Complication rates were 8.8% in younger patients & 8.4% in the elderly (local) and 7.8% & 8.4% (SAE). Overall in-hospital mortality was 1.9% in the younger patients and 2.8% in the elderly. Comparing patients 65-75yrs. to ≥ 75yrs., patients ≥ 75yrs. showed a significantly worse KPI on admission and discharge (p=0.015 & 0.008).
Conclusion: Advanced age should not preclude surgical treatment for MSCC. Surgery for MSCC in the elderly is safe and has a significant beneficial impact on the patients' postoperative functional status, and many regain ambulation.
