Iida Keiichiro, Sugita Toshiaki, Fujiwara Toshifumi, Saiwai Hirokazu
Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, JPN.
Cureus. 2024 Jul 13;16(7):e64458. doi: 10.7759/cureus.64458. eCollection 2024 Jul.
Surgery could regain the ability to walk even in non-ambulatory patients with spinal cord compression due to metastatic spine disease. However, many patients cannot reach the stage of independent ambulation because most are at an advanced disease stage. This study investigated the regained independent ambulation rate after surgery and prognostic factors for independent ambulation after metastatic spinal cord compression surgery.
In a retrospective cohort study, 38 non-ambulatory patients with spinal metastases at the cervical or thoracic lesions, who underwent surgery, were included. All surgeries were performed using laminectomy and posterior fixation. Recovery rates of independent ambulation and its prognostic factors were examined. Independent ambulation was defined as the use of a walking aid without wheelchair requirement. Factors, including age, tumor type, visceral organ metastasis, past systematic cancer therapy, neurological grade, the time from leg-symptom onset to non-ambulatory stage, and the time from non-ambulatory stage to surgery, were investigated.
The regained independent ambulation rate was 18% (7/38). Compared to non-ambulatory patients, those who regained independent ambulation were more likely to have less past systematic therapy (14% [1/7] vs. 74% [23/31], P=0.003) and slow paralysis progression (over seven days from leg-symptom onset to non-ambulatory stage) (86% [6/7] vs. 23% [7/31], P=0.002).
Recovery to independent ambulation in non-ambulatory patients with metastatic spinal cord compression was poor, even if surgery was performed. Absence of past systematic therapy and slow paralysis progression were favorable factors for regaining independent ambulation.
对于因转移性脊柱疾病导致脊髓受压的非行走患者，手术可以使其重新获得行走能力。然而，许多患者无法达到独立行走阶段，因为大多数患者处于疾病晚期。本研究调查了转移性脊髓受压手术后重新获得独立行走的比率以及独立行走的预后因素。
在一项回顾性队列研究中，纳入了38例因颈椎或胸椎病变导致脊柱转移且接受手术的非行走患者。所有手术均采用椎板切除术和后路固定术。研究了独立行走的恢复率及其预后因素。独立行走定义为使用助行器且无需轮椅辅助。研究了包括年龄、肿瘤类型、内脏器官转移、既往全身癌症治疗情况、神经功能分级、从腿部症状出现到非行走阶段的时间以及从非行走阶段到手术的时间等因素。
重新获得独立行走的比率为18%（7/38）。与非行走患者相比，重新获得独立行走的患者更有可能既往接受的全身治疗较少（14% [1/7] 对74% [23/31]，P = 0.003）且瘫痪进展缓慢（从腿部症状出现到非行走阶段超过7天）（86% [6/7] 对23% [7/31]，P = 0.002）。
对于转移性脊髓受压的非行走患者，即使进行了手术，恢复到独立行走的情况也较差。既往未接受全身治疗和瘫痪进展缓慢是重新获得独立行走的有利因素。
