Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Clin Neurol Neurosurg. 2021 Mar;202:106509. doi: 10.1016/j.clineuro.2021.106509. Epub 2021 Jan 22.
Metastatic spinal cord compression (MSCC) is a frequent phenomenon in cancer disease, often leading to severe neurological deficits. Especially in patients with complete motor paralysis, regaining the ability to walk is an important treatment goal. Our study, therefore, aimed to assess the neurological outcome of patients with MSCC and complete motor paralysis after decompressive surgery.
Patients with MSCC and complete motor paralysis, surgically treated by decompressive surgery between 2004-2014 at a single institution were retrospectively analyzed. Clinical patient data were collected from medical records. To assess the neurological outcome, Frankel grade (FG) at admission and discharge were compared. Statistical analysis was performed to identify factors associated with an ambulatory status after surgery.
Twenty-eight patients were included in this study. The majority of metastases (57 %) were located in the thoracic spine and 75 % showed extraspinal tumor spread. The median interval between loss of ambulation and surgery was 35 h (IQR: 29-70). Posterior circumferential decompression without stabilization was performed in all cases within 24 h of admission. Neurological function improved in 17 patients (63 %) and seven (26 %) even regained the ability to walk following surgery. The rate of complications was low (7%). In statistical analysis, only the Karnofsky Performance Index (KPI) displayed a significant predictive value for an ambulatory status at discharge.
Our findings indicate that severely affected MSCC patients with complete motor paralysis might benefit from decompressive surgery even when the loss of ambulation occurred more than 24 h ago.
转移性脊髓压迫（MSCC）是癌症疾病中的一种常见现象，常导致严重的神经功能缺损。特别是在完全运动瘫痪的患者中，恢复行走能力是一个重要的治疗目标。因此，我们的研究旨在评估 MSCC 患者和完全运动瘫痪患者接受减压手术后的神经功能预后。
回顾性分析了 2004 年至 2014 年在一家机构接受减压手术治疗的 MSCC 和完全运动瘫痪患者。从病历中收集临床患者数据。为了评估神经功能预后，比较了入院时和出院时的 Frankel 分级（FG）。进行了统计学分析，以确定与手术后步行状态相关的因素。
本研究纳入了 28 例患者。大多数转移瘤（57%）位于胸椎，75%有脊柱外肿瘤扩散。丧失活动能力与手术之间的中位时间间隔为 35 小时（IQR：29-70）。所有患者均在入院后 24 小时内接受了后路全环减压而未进行稳定术。17 例患者（63%）的神经功能得到改善，7 例（26%）患者在手术后甚至恢复了行走能力。并发症发生率较低（7%）。在统计学分析中，只有 Karnofsky 表现指数（KPI）对出院时的步行状态具有显著的预测价值。
我们的研究结果表明，即使在丧失活动能力超过 24 小时后，严重影响的 MSCC 患者和完全运动瘫痪患者也可能从减压手术中获益。
