Itshayek Eyal, Or Omer, Kaplan Leon, Schroeder Josh, Barzilay Yair, Rosenthal Guy, Shoshan Yigal, Fraifeld Shifra, Cohen José E
Neurol Res. 2014 Jun;36(6):530-43. doi: 10.1179/1743132814Y.0000000368. Epub 2014 Apr 16.
We aimed to assess the efficacy of surgical decompression of metastatic epidural spinal cord compression (MESCC) in patients ≧65 years and review our multidisciplinary surgical decision-making process.
We identified all patients operated for MESCC from August 2008 to June 2012. Patients ≧65 years, with a single area of cord compression, back/radicular pain, neurological signs of cord compression, surgery within 48 hours after onset of MESCC-related paraplegia, and follow-up for ≧1 year or until death were included. Files were reviewed retrospectively. The requirement for informed consent was waived. Neurological status was assessed with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). Duration of ambulation and survival were assessed with Kaplan-Meier and Cox regression analysis.
Twenty-one patients met inclusion criteria (11 women/10 men; mean age 73 years, range 65-87). All presented with debilitating back/neck pain. Ten patients (48%) were not ambulatory before surgery and four suffered urinary incontinence/constipation (19%). Preoperative AIS was E in 5 patients (24%), D in 11 (62%), and C in 5 (24%). Motor symptoms had been present for a mean of 3·8 days (range 1-14). All patients regained ambulation. Overall, mean survival was 320 days (range 19-798) and mean ambulation was 302 days (range 18-747). On 31 March 2013, 7 patients (33%) were alive and ambulatory at a mean of 459 days (range 302-747); 14 patients had died (67%) at a mean of 251 days (range 19-798), with a mean ambulation of 223 days (range 18-730).
With careful patient selection, surgery may achieve long duration of ambulation in patients ≧65 years with MESCC.
我们旨在评估手术减压治疗65岁及以上转移性硬膜外脊髓压迫症（MESCC）的疗效，并回顾我们多学科的手术决策过程。
我们确定了2008年8月至2012年6月期间所有接受MESCC手术的患者。纳入年龄≥65岁、脊髓压迫为单一部位、有背部/神经根性疼痛、脊髓压迫的神经学体征、在MESCC相关截瘫发作后48小时内接受手术且随访≥1年或直至死亡的患者。对病历进行回顾性分析。免除了知情同意的要求。采用美国脊髓损伤协会（ASIA）损伤量表（AIS）评估神经学状态。采用Kaplan-Meier法和Cox回归分析评估行走时间和生存期。
21例患者符合纳入标准（11例女性/10例男性；平均年龄73岁，范围65 - 87岁）。所有患者均有严重的背部/颈部疼痛。10例患者（48%）术前不能行走，4例有尿失禁/便秘（19%）。术前AIS分级为E级的有5例（24%）, D级的有11例（62%），C级的有5例（24%）。运动症状出现的平均时间为3.8天（范围1 - 14天）。所有患者均恢复了行走能力。总体而言，平均生存期为320天（范围19 - 798天），平均行走时间为302天（范围18 - 747天）。截至2013年3月31日，7例患者（33%）存活且能行走，平均时间为459天（范围302 - 747天）；14例患者（67%）死亡，平均时间为251天（范围19 - 798天），平均行走时间为223天（范围18 - 730天）。
通过仔细选择患者，手术可使65岁及以上的MESCC患者获得较长的行走时间。
