The impact of surgical timing on neurological outcomes and survival in patients with complete paralysis caused by spinal tumours

2019 ◽  
Vol 101-B (7) ◽  
pp. 872-879 ◽  
Author(s):  
S. Li ◽  
N. Zhong ◽  
W. Xu ◽  
X. Yang ◽  
H. Wei ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Regression Analysis ◽  
Spinal Cord Compression ◽  
Univariate Analysis ◽  
Cord Compression ◽  
Timing Of Surgery ◽  
Neurological Recovery ◽  
Cox Regression Analysis ◽  
Complete Paralysis ◽  
The Impact

Aims The aim of this study was to explore the prognostic factors for postoperative neurological recovery and survival in patients with complete paralysis due to neoplastic epidural spinal cord compression. Patients and Methods The medical records of 135 patients with complete paralysis due to neoplastic cord compression were retrospectively reviewed. Potential factors including the timing of surgery, muscular tone, and tumour characteristics were analyzed in relation to neurological recovery using logistical regression analysis. The association between neurological recovery and survival was analyzed using a Cox model. A nomogram was formulated to predict recovery. Results A total of 52 patients (38.5%) achieved American Spinal Injury Association Impairment Scale (AIS) D or E recovery postoperatively. The timing of surgery (p = 0.003) was found to be significant in univariate analysis. In multivariate analysis, surgery within one week was associated with better neurological recovery than surgery within three weeks (p = 0.002), with a trend towards being associated with a better neurological recovery than surgery within one to two weeks (p = 0.597) and two to three weeks (p = 0.055). Age (p = 0.039) and muscle tone (p = 0.018) were also significant predictors. In Cox regression analysis, good neurological recovery (p = 0.004), benign tumours (p = 0.039), and primary tumours (p = 0.005) were associated with longer survival. Calibration graphs showed that the nomogram did well with an ideal model. The bootstrap-corrected C-index for neurological recovery was 0.72. Conclusion In patients with complete paralysis due to neoplastic spinal cord compression, whose treatment is delayed for more than 48 hours from the onset of symptoms, surgery within one week is still beneficial. Surgery undertaken at this time may still offer neurological recovery and longer survival. The identification of the association between these factors and neurological recovery may help guide treatment for these patients. Cite this article: Bone Joint J 2019;101-B:872–879.

Metastatic epidural spinal cord compression: does timing of surgery influence the chance of neurological recovery? An observational case-control study

2018 ◽  
Vol 26 (9) ◽  
pp. 3181-3186
Author(s):  
Valerio Pipola ◽  
Silvia Terzi ◽  
Giuseppe Tedesco ◽  
Stefano Bandiera ◽  
Giovanni Barbanti Bròdano ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Case Control Study ◽  
Cord Compression ◽  
Case Control ◽  
Timing Of Surgery ◽  
Neurological Recovery ◽  
Control Study

scholarly journals Spontaneous Spinal Epidural Haematomas and the Prognostic Implications of Interval to Surgical Decompression: A Report of Two Cases

2009 ◽  
Vol 17 (2) ◽  
pp. 216-219 ◽  
Author(s):  
Colin Yi-Loong Woon ◽  
Benedict Chan-Wearn Peng ◽  
John Li-Tat Chen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Lower Limb ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Neurological Recovery ◽  
Uncontrolled Hypertension ◽  
Motor Deficit ◽  
Mri Features ◽  
Spinal Epidural

Spontaneous spinal epidural haematomas (SSEHs) are rare causes of spinal cord compression. We present 2 cases of thoracic SSEHs with similar magnetic resonance imaging (MRI) features. Patient 1 was on long-term oral anticoagulants and patient 2 had uncontrolled hypertension. Patient 1 presented with a dense motor deficit, whereas patient 2 developed progressive lower limb weakness. Decompression laminectomy and haematoma evacuation was performed 51 hours later for patient 1 and 14 hours later for patient 2. Both had recovered their lower limb power, but neurological recovery was greater for patient 2. In patients with bleeding diatheses or uncontrolled hypertension, acute SSEHs must be suspected when they present with atraumatic back pain and signs of spinal cord compression. The interval to surgical decompression greatly influences the prognosis for neurological recovery.

Neurological Recovery Is Impaired by Concurrent but Not by Asymptomatic Pre-existing Spinal Cord Compression After Traumatic Spinal Cord Injury

Spine ◽  
2012 ◽  
Vol 37 (17) ◽  
pp. 1448-1455 ◽  
Author(s):  
Kensuke Kubota ◽  
Hirokazu Saiwai ◽  
Hiromi Kumamaru ◽  
Kazu Kobayakawa ◽  
Takeshi Maeda ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Recovery ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury

scholarly journals Nursing considerations for supporting cancer patients with metastatic spinal cord compression: a literature review

2019 ◽  
Vol 28 (17) ◽  
pp. S24-S29
Author(s):  
Rebecca Troke ◽  
Tanya Andrewes
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Metastatic Spinal Cord Compression ◽  
Research Papers ◽  
Patients With Cancer ◽  
Nurses Role ◽  
The Impact

Background: metastatic spinal cord compression (MSCC) is an oncology emergency. Prevalence is increasing. Treatment and care are complex and those diagnosed may be faced with life-changing challenges. Aims: to review the impact and management of MSCC in patients with cancer, in order to analyse nursing considerations for supporting patients. Methods: a literature review and thematic analysis of five primary research papers, published between 2009 and 2014. Findings: two themes of prognosis/survival time and independence versus dependence were discovered. Conclusions: the onset of MSCC may result in paralysis and associated loss of independence, impacting on a patient's quality of life. Understanding individuals' prognosis and treatment/care preferences is fundamental for the sensitive, individualised support of patients with MSCC. The findings reinforce the nurses' role in health education, in order to raise awareness of MSCC and promote early diagnosis so that patients maintain function and independence as long as possible. The findings support the need for nurses to be equipped with appropriate communication skills to initiate and engage in sensitive, difficult and proactive conversations with patients and their families, supporting the delivery of humanised care.

scholarly journals Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression

2012 ◽  
Vol 22 (6) ◽  
pp. 1383-1388 ◽  
Author(s):  
N. A. Quraishi ◽  
T. S. Rajagopal ◽  
S. R. Manoharan ◽  
S. Elsayed ◽  
K. L. Edwards ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Neurological Outcome ◽  
Cord Compression ◽  
Timing Of Surgery ◽  
Metastatic Spinal Cord Compression

scholarly journals Outcomes of Palliative Radiotherapy in Metastatic Epidural Spinal Cord Compression in Lung Cancer—A Prospective Observational Study from Tata Memorial Hospital

2021 ◽  
Vol 10 (02) ◽  
pp. 120-126
Author(s):  
Anil Tibdewal ◽  
Alisha Sharma ◽  
Lavanya Gurram ◽  
Naveen Mummudi ◽  
Jaiprakash Agarwal
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Univariate Analysis ◽  
Cord Compression ◽  
Dose Fractionation ◽  
Rank Test ◽  
P Value ◽  
Sphincter Function ◽  
Nonsignificant Difference

Abstract Background Metastatic epidural spinal cord compression (MESCC) secondary to lung cancer (LC) is a debilitating complication associated with poor prognosis and is commonly treated with radiotherapy (RT). There is no consensus for RT dose fractionation in spinal cord compression. Methods Forty consecutive patients of LC with radiological evidence of MESCC treated with palliative RT were evaluated for functional outcomes (pain, ambulation, and sphincter function) at 2-, 4-, and 24-week post RT completion. Pain assessment was done using visual analogue scale (VAS) and response was categorized according to international consensus criteria, ambulation status (AS) using Tomita’s scale, and sphincter function by the presence or absence of a catheter. Overall survival (OS) was assessed using Kaplan-Meier method and compared using log-rank test. Impact of potential prognostic factors on survival was also analyzed and p-value ≤0.05 was considered significant. Results Sixteen, 22, and two patients received 8 Gy single fraction (SF), 20 Gy in five fractions (20/5), and 30 Gy in 10 fractions (30/10), respectively. At 2 weeks, overall response (OR) rates of pain, ambulation, and sphincter control were 73, 81, and 81%, respectively. At 4 and 24 weeks, 93.7, 84.3, 87.5% and 88, 94, 76.5% had OR, respectively. Median OS was 4 months. Six- and 12-months OS was 50 and 37.5%. Nonsignificant difference in OS was seen between SF and 20/5 fractions (median 2.2 vs. 7.1 months, p = 0.39). Age ≤50 years was the only significant factor (p <0.05) in univariate analysis for OS. Conclusion Radiotherapy provided equivalent pain control, ambulation, and sphincter function compared with reported literature in MESCC. Nonsignificant difference in OS exists between SF and multifraction RT regimens.

Impact of skeletal-related events on survival in patients with prostate cancer metastatic to bones.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 223-223
Author(s):  
Jean A. McDougall ◽  
Bernardo Haddock Lobo Goulart ◽  
Sean D Sullivan ◽  
Jeannine S. McCune ◽  
Aasthaa Bansal ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Metastatic Prostate Cancer ◽  
Pathological Fracture ◽  
Cord Compression ◽  
Time Dependent ◽  
Risk Of Death ◽  
Skeletal Related Events ◽  
The Impact

223 Background: Skeletal related events (SREs), defined as pathological fracture, spinal cord compression, surgery or radiotherapy to the bone, occur in nearly half of men diagnosed with metastatic prostate cancer. Accurate assessment of the risk of death associated with SREs is important to making decisions about the use of recently approved treatments, which have been shown to decrease the frequency of skeletal events, yet estimating the impact of SREs on survival presents several methodological challenges given the recurrent time-dependent nature of exposure. Methods: A cohort of men >65years of age, diagnosed with prostate cancer and bone metastasis between January 1, 2004 and December 31, 2009 was identified from the Surveillance Epidemiology and End Results (SEER) registries were linked to Medicare Parts A and B claims. The outcome of interest, death from any cause, was ascertained from SEER and survival time was calculated from the date of metastatic prostate cancer diagnosis. Multivariable Cox proportional hazards models treating the occurrence of an SRE as a time-dependent exposure were used to estimate the hazard ratios (HR) and corresponding 95% confidence intervals (CI) for the association between SRE occurrence, number, and type, and death. Results: Among 3,297 men with metastatic prostate cancer, 40% experienced ≥1 SRE during the observational follow-up period (median 19 months). Compared to men who remained SRE-free, cohort members who had ≥1 SREs had a two-fold higher risk of death (HR 2.2, 95% CI 2.0-2.4). Those whose first SRE was a pathological fracture had a 2.7-fold higher risk of death (HR 2.7, 95% CI 2.3-3.1), followed by spinal cord compression (HR 2.1, 95% CI 1.8-2.5), surgery (HR 1.8, 95% CI 1.5-2.2) and radiotherapy (HR 2.2, 95% CI 1.9-2.4). Compared to those experiencing only one SRE, men who experienced a second SRE of any type had double the risk of death (HR 2.2, 95% CI 1.9-2.6). Conclusions: SREs were associated with ≥50% reduction in overall survival. This finding is consistent across different types of SREs and supports using therapies to prevent or treat SREs in patients with prostate cancer metastatic to the bones.

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