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Clinical outcomes and significant factors in the survival rate after decompression surgery for patients who were non-ambulatory due to spinal metastases.
- Source :
-
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association [J Orthop Sci] 2019 Mar; Vol. 24 (2), pp. 347-352. Date of Electronic Publication: 2018 Oct 25. - Publication Year :
- 2019
-
Abstract
- Background: The development of effective chemotherapy regimens and molecular targeting agents are improving the overall survival rates in patients with cancer. However, patients who are non-ambulatory due to metastatic epidural spinal cord compression (MESCC) may be assessed as unable to tolerate chemotherapy secondary to poor performance status. This means that the ambulatory status of patients with cancer might be significant for survival time.<br />Methods: We investigated the functional outcomes and factors influencing overall survival in 31 patients who were non-ambulatory due to MESCC and underwent decompression surgery. The functional outcome was determined by the Frankel grading system.<br />Result: Twenty-one patients (68%) improved by at least 1 Frankel grade; 17 patients (55%) became ambulatory postoperatively. Most of postoperatively ambulatory patients could undergo postoperative chemotherapy (14/17, 82%). On the other hand, only a few postoperatively non-ambulatory patients could undergo postoperative chemotherapy (2/15, 13%). We observed a complication rate of 35.5% with specific complications including wound infection, pneumonia, and deep vein thrombosis/pulmonary embolus. The median survival duration was 7.0 months. Factors that significantly affected the overall survival in univariate analyses were revised Tokuhashi score (RTS) ≥ 4, postoperative chemotherapy, ambulatory status, and complications (RTS ≥ 4, P < 0.05; postoperative chemotherapy, P < 0.001; ambulatory status, P < 0.001; complications, P < 0.01).<br />Conclusions: Decompression surgery for patients who are non-ambulatory due to MESCC directly contributes to functional outcomes and may indirectly contribute to overall survival. If non-ambulatory patients who are assessed as unable to tolerate chemotherapy due to poor performance status regain the ability to walk by decompression surgery, they will have a chance to receive postoperative chemotherapy, thereby increasing their chances of prolonging survival. However, postoperative complications may shorten their survival; therefore, we should carefully consider the surgical indications. RTS is useful for judging the surgical indication.<br /> (Copyright © 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Adult
Aged
Chemotherapy, Adjuvant
Cohort Studies
Decompression, Surgical mortality
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Care methods
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Spinal Cord Compression diagnostic imaging
Spinal Cord Neoplasms mortality
Spinal Cord Neoplasms secondary
Survival Rate
Time Factors
Treatment Outcome
Walking
Decompression, Surgical methods
Disability Evaluation
Spinal Cord Compression etiology
Spinal Cord Compression surgery
Spinal Cord Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1436-2023
- Volume :
- 24
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
- Publication Type :
- Academic Journal
- Accession number :
- 30482604
- Full Text :
- https://doi.org/10.1016/j.jos.2018.10.003