Metastatic spinal cord compression (MSCC) treated with palliative decompression: Surgical timing and survival rate
Journal
PLoS ONE
Journal Volume
12
Journal Issue
12
Pages
e0190342
Date Issued
2017
Author(s)
Lo W.-Y.
Abstract
Background Metastatic spinal cord compression (MSCC) treatment depends on life expectancies. Data regarding palliative decompression outcomes is scarce. We demonstrate that surgical timing has a significant impact on survival in MSCC patients treated with palliative decompression. Methods Eighty-nine consecutive MSCC patients at a tertiary referral medical center were enrolled between January 2012 and February 2016. Wide laminectomy was performed for tumors invading the vertebral body. Debulking surgery was done for tumors damaging the posterior column of the spine. Patient records were retrospectively analyzed. Results Better survival was observed in patients with preoperative intact motor function (Group A, n = 37) than in those with motor deficit (Group B, n = 52, p = 0.0031). In Group B, survival was better in those who underwent surgery within 7 days of motor deficit onset than in those who underwent surgery 7 days after onset (p = 0.0444) and in postoperative ambulant patients than in nonambulant patients (p = 0.0120). In Group B, Frankel grade improved in patients who underwent surgery within 48 h than in those who underwent surgery after 48 h (p = 0.0992). Group A patients had a shorter hospital stay and higher revised Tokuhashi score than Group B patients. Overall survival was better in patients with a lower Tomita score (5, p = 0.0012), higher revised Tokuhashi score (9, p = 0.0009), better preoperative Frankel grade (p < 0.0001), and younger age (55 years, p = 0.0179). There were no significant differences in age, sex, tumor type, involved vertebrae level, Tomita score, intrao-perative blood loss, operation time, incidence of infection, and postoperative complications between groups. Conclusion We can improve the survival of MSCC patients with palliative decompression before motor deficits occur. After motor deficit onset, survival can still be improved with surgery within 7 days. Overall survival was better in patients aged 55 years. ? 2017 Lo, Yang. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
adult; Article; chi square test; clinical protocol; cohort analysis; controlled study; decompression surgery; female; Fisher exact test; good clinical practice; hospitalization; human; kyphoplasty; laminectomy; length of stay; major clinical study; male; metastatic spinal cord compression; middle aged; motor performance; operation duration; percutaneous vertebroplasty; postoperative complication; practice guideline; quality of life; retrospective study; scoring system; spinal cord compression; surgical approach; survival rate; survival time; Tomita score; Wilcoxon signed ranks test; metastasis; palliative therapy; pathophysiology; spinal cord compression; survival analysis; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Palliative Care; Retrospective Studies; Spinal Cord Compression; Survival Analysis
Publisher
Public Library of Science
Type
journal article