Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression
Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression
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DOI：
10.1227/01.neu.0000317317.33365.15
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发表时间：
2008-03-01
期刊：
影响因子：
4.8
通讯作者：
Gokaslan, Ziya
中科院分区：
文献类型：
--
作者：
Chaichana, Kaisorn L.;Woodworth, Graeme F.;Gokaslan, Ziya
目的：转移性硬膜外脊髓压迫(MESCC)是转移性疾病的一种相对常见且使人衰弱的并发症，常导致神经功能障碍。本研究旨在探讨MESCC减压术后维持和恢复步行功能的相关性。方法：对1995年至2005年间在一家学术三级护理机构接受MESCC减压术的78例患者进行了回顾分析。采用Fisher‘s精确分析方法比较术前非卧床与非卧床患者的疗效。多因素COX比例风险回归用于确定与维持或恢复行走能力之间的关系。结果：患者术后随访7.1+/-1.6个月(平均+/-标准差)。与术前非卧床患者相比，术前非卧床患者需要更广泛的手术(增加手术脊柱水平和椎板切除次数)，并且有更多的手术部位并发症(伤口裂开和脑脊液漏)。从多变量分析来看，术前独立行走能力(相对风险[RR]，2.320；95%可信区间[CI]，1.301-4.416；P<；0.01)在最后一次随访评估时，独立行走的可能性增加2.3%。病理性椎体压缩骨折(RR，0.471；9.5%CI，0.235-0.864；P=0.01)独立地将最后一次随访评估时行走的可能性降低2.1%。对于手术时不能行走的患者，术前放射治疗(RR，0.406；95%CI，0.124-0.927；P=0.03)使恢复行走能力的可能性降低2.5%。术后症状持续时间少于48小时(RR，2.925；95%CI，1.133~2.925；P=0.02)和术后放疗(RR，2.595；95%CI，1.039~8.796；P=0.04)可使患者恢复行走能力的可能性分别增加2.9%和2.6%。
OBJECTIVE: Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. This study was designed to explore associations with maintaining and regaining ambulatory function after decompressive surgery for MESCC.METHODS: Seventy-eight patients undergoing decompressive surgery for MESCC at an academic tertiary care institution between 1995 and 2005 were retrospectively reviewed. Fisher's exact analysis was used to compare preoperative ambulatory and nonambulatory patients. Multivariate Cox proportional hazards regression was used to identify associations with either maintaining or regaining the ability to walk.RESULTS: Patients were followed for 7.1 +/- 1.6 (mean +/- standard deviation) months after surgery. Preoperative nonambulatory patients required more extensive surgery (increased operative spinal levels and number of laminectomies) and had more surgical site complications (wound dehiscences and cerebrospinal fluid leaks) compared with preoperative ambulatory patients. From the multivariate analysis, preoperative ability to walk (relative risk [RR], 2.320; 95% confidence interval [CI], 1.301-4.416; P < 0.01) independently increased the likelihood of ambulation at the last follow-up evaluation 2.3-fold. Pathological vertebral compression fracture at presentation (RR, 0.471; 9.5% CI, 0.235-0.864; P = 0.01) independently decreased the likelihood of ambulation at the time of the last follow-up evaluation 2.1-fold. For patients unable to walk at the time of surgery, preoperative radiation therapy (RR, 0.406; 95% CI, 0.124-0.927; P = 0.03) decreased the likelihood of regaining the ability to walk 2.5-fold. Symptoms present for less than 48 hours (RR, 2.925; 95% CI, 1.133-2.925; P = 0.02) and postoperative radiotherapy (RR, 2.595; 95% CI, 1.039-8.796; P = 0.04) independently increased the likelihood of regaining ambulatory ability 2.9- and 2.6-fold, respectively, by the time of last follow-up evaluation.CONCLUSION: The identification of these associations with neurological outcome may help guide in the preservation or return of ambulation after surgery for patients with MESCC.