Article
Tumour-related paraplegia – analysis of an individual and interdisciplinary initial treatment
Der tumorbedingte Querschnitt – Analyse einer individuellen und interdisziplinären Erstbehandlung
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Authors
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Thomas Liebscher
- Unfallkrankenhaus Berlin, Behandlungszentrum für Rückenmarkverletzte, Berlin, Deutschland; Charité – Universitätsmedizin Berlin, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Deutschland
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Martin Kreutzträger
- Unfallkrankenhaus Berlin, Behandlungszentrum für Rückenmarkverletzte, Berlin, Deutschland
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Tom Lübstorf
- Charité – Universitätsmedizin Berlin, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Deutschland
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Thomas Auhuber
- Unfallkrankenhaus Berlin, Medizinmanagement, Berlin, Deutschland
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Grit Wüstner
- Unfallkrankenhaus Berlin, Controlling, Berlin, Deutschland
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Axel Ekkernkamp
- Unfallkrankenhaus Berlin, Klinik für Unfallchirurgie und Orthopädie, Berlin, Deutschland
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Marcel Kopp
- Charité – Universitätsmedizin Berlin, Klinik für Neurologie und Abteilung für Experimentelle Neurologie, Berlin, Deutschland; Berliner Institut für Gesundheitsforschung, QUEST- BIH Center for Transforming Biomedical Research, Berlin, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: The initial treatment of spinal cord injury (SCI) is based on the concept of comprehensive care. Due to its surgical severity and acute spinal paralysis, initial spine surgery represents a major challenge for spine centres. Due to the exceptional conditions of tumour-related SCI, its treatment requires individual and interdisciplinary approaches. The aim of the study is the descriptive analysis of treatment, outcome, duration of stay and costs compared to traumatic and inflammatory SCI.
Methods: Within the scope of monocentric care research, parameters of patients with acute paraplegia were analyzed from 2011 to 2017. A total of 365 patients (traumatic n=246; inflammatory n=64; tumorous n=55) were included and descriptively analysed.
Results: Characteristic for tumor-related SCI were the higher age (MW: 68 years) and the high proportion of incomplete SCI at admission (71%), which was similar to inflammatory SCI (Table 1 [Tab. 1]). In 50% of the cases the thoracic spine was affected. In 87% of the cases spine surgery was performed. The spine surgery complications (9%) were lower compared to the more complex injury patterns after traumatic SCI (24%). Due to the more incomplete tumor-related SCI cases and the non-inflammatory cause, the urinary tract infections, lung infections and the multi-resistant pathogen detection (13%, 9% and 7%) were lower in comparison (Table 1 [Tab. 1]). 16% of patients died during initial treatment and 88% of these patient’s will was documented. Due to the oncological further treatment, the time of the first treatment (mean 23 days) and the associated total costs (mean 19300,- €) were comparatively low (Table 2 [Tab. 2]).
Conclusion: Patient will and therapy objectives are the foundation of the initial treatment of a tumor-related paraplegia. Spine surgery, tumor board and paraplegiology should closely collaborate to achieve optimal patient care with low SCI-associated complications in the palliative situation.
