Curative Effect And Prognostic Factors Analysis Of Posterior Decompression And Stabilization For Spinal Metastatic Epidural Spinal Cord Compression

Background Metastatic epidural spinal cord compression(MESCC)is defined as secondary spinal cord compression caused by malignant tumor metastasis to the spinal or epidural gap.Clinical symptoms include pain,sensory dysfunction,motor dysfunction,rectal/bladder sphincter dysfunction.MESCC is common complication of malignant tumor,such as thyroid cancer,lung cancer,breast cancer,prostate cancer,which not only increase the patients medical risks and costs,but also seriously affect life quality and survival.Objective To investigate the curative effect of posterior laminectomy decompression and stabilization for MESCC and prognostic factors of postoperative ambulation and survival.Methods Sixty-seven consecutive patients with MESCC who were performed with posterior laminectomy decompression and stabilization from January 2010 to December2014 were retrospectively in this study.Visual analog score(VAS)was used to evaluate pain intensity.The Eastern Cooperative Oncology Group(ECOG)performance status was used to evaluate patient's general condition.Frankel grade was used to evaluate neurological dysfunction.Bilsky score was used to evaluate degree of spinal cord compression.Clinical data such as age,primary tumor,interval from cancer diagnosis to spinal metastases,preoperative visceral metastases,number of involved vertebrae,compression fracture,location of compression,number of extraspinal bone metastasis, preoperative ECOG,preoperative ambulatory status,duration of motor dysfunction and postoperative adjuvant radiotherapy were recorded.Results The average follow-up period was 11.7 months.Postoperative 4 weeks VAS score significantly decreased from preoperative 5.67±1.67 to 2.11±1.39(P<0.001).there was significant difference between preoperative and postoperative walk rate(57% vs78%,P=0.01).Postoperative ECOG score significantly decreased from preoperative2.79 score to 1.98 score(P=0.015).Postoperative Frankel grade was improved in 52%patients,maintained in 43% and retrogressive in 5%.there was significant difference between preoperative and postoperative 4 weeks Frankel grade.Number of involved vertebrae,compression fracture,location of compression had no significant influence on postoperative ambulatory status(P>0.05).Preoperative ECOG score,preoperative ambulatory status,duration of motor dysfunction,Bilsky score had significant influence on postoperative ambulatory status(P<0.05).Univariate analysis showed that age,primary tumor,preoperative ECOG score,visceral metastases,interval from cancer diagnosis to spinal metastases,number of involved vertebrae,postoperative adjuvant radiotherapy had significant influence on postoperative survival(P<0.05).Multivariate analysis showed that age,primary tumor,preoperative ECOG score,visceral metastases,postoperative adjuvant radiotherapy had significant influence on postoperative survival(P<0.05).Conclusions On the premise of reducing complications,patients with symptomatic MESCC were recommended to surgery as soon as possible.Posterior laminectomy decompression and stabilization for MESCC can effectively relieving pain,improving neurological function,improving the quality of life.Lower preoperative ECOG score,better preoperative ambulatory status,shorter duration of motor dysfunction,lower degree of spinal cord compression indicated better postoperative ambulatory status.Age, primary tumor,preoperative ECOG score,visceral metastases,postoperative adjuvant radiotherapy were important prognostic factors for postoperative survival.