Suzuki Tetsuya, Tsuji Osahiko, Ichikawa Masahiko, Ishii Ryota, Nagoshi Narihito, Kawakami Michiyuki, Watanabe Kota, Matsumoto Morio, Tsuji Tetsuya, Fujiwara Toshiyuki, Nakamura Masaya
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Asian Spine J. 2023 Apr;17(2):355-364. doi: 10.31616/asj.2022.0068. Epub 2023 Jan 10.
This is a single-center retrospective cohort study with a university hospital setting.
This study aims to evaluate the short-term course of physical function and walking ability after intramedullary spinal cord tumor (ISCT) resection and predict walking independence 1 year after surgery.
Although several reports have shown the postoperative functional prognosis of spinal intramedullary tumors with long-term follow-up, no reports have identified the predictors associated with the functional outcome at an early stage.
A total of 79 individuals who underwent ISCT resection at our institute between 2014 and 2019 were enrolled in the study, whose preoperative walking state was independent ambulator regardless of cane support with the Functional Independence Measure Locomotor Scale (FIM-L) score of ≥6. The FIM-L, the American Spinal Injury Association (ASIA) motor and sensory scores in the lower extremities, and the Walking Index for Spinal Cord Injury II (WISCI II) were assessed for walking independence, lower-limb function, and walking ability, respectively. These evaluations were performed at 4 time points: preoperatively, 1 week (1W), 2 weeks (2W), and 1 year after surgery.
In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93-1.00).
The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.
这是一项在大学医院环境下开展的单中心回顾性队列研究。
本研究旨在评估髓内脊髓肿瘤（ISCT）切除术后身体功能和步行能力的短期病程，并预测术后1年的步行独立性。
尽管有几份报告显示了脊髓髓内肿瘤术后长期随访的功能预后，但尚无报告确定早期与功能结果相关的预测因素。
本研究纳入了2014年至2019年间在我院接受ISCT切除的79例患者，其术前步行状态为独立行走者，无论是否使用拐杖辅助，功能独立性测量运动量表（FIM-L）得分≥6分。分别采用FIM-L、美国脊髓损伤协会（ASIA）下肢运动和感觉评分以及脊髓损伤步行指数II（WISCI II）评估步行独立性、下肢功能和步行能力。这些评估在4个时间点进行：术前、术后1周（1W）、术后2周（2W）和术后1年。
在术后早期，分别有71%和43%的参与者在1W和2W时为非独立行走者。组织病理学显示，实体瘤（室管膜瘤、星形细胞瘤或脂肪瘤）患者在1W和2W时的指标显著低于血管性肿瘤（血管母细胞瘤或海绵状血管瘤）患者。关于肿瘤位置，与颈椎病例相比，胸椎病例在1W和2W时下肢功能较差，在2W时步行能力较差。根据受试者工作特征（ROC）分析，2W时的WISCI II得分为2分在预测术后1年步行独立性水平方面具有最高的敏感性（100%）和特异性（92.2%）（ROC曲线下面积为0.99（95%置信区间，0.93-1.00））。
ISCT切除术后1年，早期下肢功能评分越高，预测的步行能力改善越好。
