Epidural metastatic spinal cord compression: functional outcome and survival after inpatient rehabilitation

Abstract

Study design: Retrospective descriptive study. Objectives: (1) To obtain an overall appraisal of patients with epidural metastatic spinal cord compression (SCC) (1) Clinical records were reviewed and demographic, clinical and functional data were collected according to a protocol. The date of admittance to the SCU, rehabilitation goals, date of discharge and date of death were recorded. (2) The odds ratio (OR) was calculated for all determinants on admittance to the SCU in order to find indicators that predict survival 41 year after discharge from the SCU. An OR X2 was considered to be clinically significant. Results: In total, 131 patients with epidural metastatic SCC were admitted. In all, 117 clinical records were retrieved and 97 clinical records provided complete data. The average age on admittance was 58 years. Among the patients 53% were male. The average Barthel score on admittance was 7.2/20 points. The average length of stay in the SCU was 104 days (3-336). Overall, 66% of the patients were discharged. The average Barthel score on discharge was 12.0 points. The average survival after discharge was 808 (0-3669) days. During their stay on the SCU, seven patients died. At 1 year after discharge, 52% of the patients were still alive. These patients suffered less complications, had been admitted less often to a hospital during rehabilitation, had made better functional progress and had been discharged home more often. A survival 41 year after discharge is related to ASIA D (OR 4.3), MRC 4 and 5 (OR 5.4), tumour in remission (OR 3.8) and independence or partial independence on the Barthel items: dressing (OR 4.3) and making transfers (OR 5.0). Conclusions: Patients with epidural metastatic SCC may benefit from in-patient rehabilitation.

Neoplastic myelopathies and traumatic spinal cord lesions: an Italian comparison of functional and neurological outcomes

“…The mean length of rehabilitation for NSCI patients is consistent with Eriks et al 7 According to the study by McKinley et al 4 and our findings, neoplastic patients have shorter rehabilitation stays. McKinley attributed this phenomenon to the need to discharge neoplastic patients prematurely because of their short life expectancy.…”

“…At discharge, TSCI and NSCI patients doubled their initial BI scores, which is consistent with the 66% improvement in the BI that was achieved by patients with metastatic spinal cord compressions in the study by Eriks et al 7 At discharge, TSCI patients had slightly higher BI scores than those with NSCIs, and their improvement was significantly greater, likely because they started with lower scores.…”

“…To identify patients with long life expectancies who could benefit from such a program, prognostic indicators such as young age, incomplete SCI, good functional status at admission and the scoring system of Tokuhashi et al 29 should be considered. 6,7 …”

“…[2][3][4][5][6][7][8][9][10][11][12] Most such studies, however, examined metastatic spinal cord compression only, and although they have demonstrated the benefits of rehabilitation in neoplastic patients with regard to pain, independence, prevention of complications and survival, they failed to make comparisons with traumatic SCI (TSCI) patients. [5][6][7][9][10][11][12] Thus, few studies have compared the outcomes of NSCI and TSCI patients, likely because of differences in prognostic factors (age, lesion severity and level, and lesion-to-rehabilitation hospital admission time) between these groups that render them incomparable.…”

Metastatic paraplegia: care management characteristics within a rehabilitation center

“…[1][2][3][4][5][6] Only 10-14% of patients with a spinal epidural metastasis are admitted into a PM&R center. 7 The teams are usually not used to dealing with chronic pain, fatigue and other symptoms related to metastatic paraplegia.…”