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

Abstract

Background: Although neoplastic spinal cord injuries (NSCIs) constitute B25% of all non-traumatic spinal cord lesions, patients with such pathologies are seldom, if ever, admitted to specialized centers; further, their rehabilitation typically is short because of the perception that rehabilitation prolongs hospital stays unnecessarily and is reserved only for patients with very good prognoses. Study design: This study is a retrospective analysis. Objective: The objective of this study is to evaluate the neurological and functional outcomes of patients with NSCIs compared with those of patients with traumatic spinal cord injury (TSCI). Methods: We evaluated 208 patients with TSCIs and 63 with NSCIs; using a matching cohorts procedure, 43 comparable couples were selected from each group. The measures used to assess these patients were the American Spinal Injury Association standards, the Barthel Index (BI), the Rivermead Mobility Index and the Walking Index for Spinal Cord Injury. Results: In the general population, NSCI patients are older and have longer lesion-to-admission times and more incomplete lesions than TSCI patients. Therefore, the functional status at admission and outcomes differed between the groups. In the matching cohorts, TSCI patients had lower BI scores at admission than NSCI subjects. At discharge, the two groups had comparable functional outcomes. Neurological status was similar at admission and at discharge. Conclusions: Although they had slightly disparate functional levels at admission, NSCI and TSCI patients had the same outcomes at discharge. Our data suggest that in a selected cohort of NSCI patients, rehabilitation is as successful as that in TSCI subjects and allows most patients to be discharged instead of being institutionalized.

Rehabilitation of people with spinal cord damage due to tumor: literature review, international survey and practical recommendations for optimizing their rehabilitation

“…A number of reports compared people with SCDys due to tumor to those with traumatic SCI and found that the tumor group had a shorter length of stay in SRU, comparable improvement in functional abilities and similar rates of discharge back into the community. 15,27 A number of publications reported on the functional outcomes of people with SCDys due to tumor, with the consistent finding that they had a significant functional improvement between admission and discharge. 5,15,16,26 Compared to people with traumatic SCI, however, their functional improvement was less.…”

“…15,27 A number of publications reported on the functional outcomes of people with SCDys due to tumor, with the consistent finding that they had a significant functional improvement between admission and discharge. 5,15,16,26 Compared to people with traumatic SCI, however, their functional improvement was less. 15,27 In comparison with other causes of SCDys, people with tumor have a trend towards lower functioning on admission and at discharge, and possibly lower overall change in function when compared with the other causes.…”

“…5,10,[12][13][14][15][16]25,26 The key findings from these are summarized in Table 1. A number of reports compared people with SCDys due to tumor to those with traumatic SCI and found that the tumor group had a shorter length of stay in SRU, comparable improvement in functional abilities and similar rates of discharge back into the community.…”

“…[7][8][9] The bias of SRUs against admitting people with SCDys appears to be particularly strong regarding those people with SCDys due to tumor, 10,11 although numerous SRUs do admit these patients. 5,10,[12][13][14][15][16][17] It is acknowledged that the rehabilitation of patients with tumor presents unique challenges, 18 and this applies especially for those with tumor as the cause of SCDys. 10,16,[19][20][21] Despite the high proportion of people with tumor causing SCDys there has been relatively little written about these patients in terms of the ideal setting for their rehabilitation or recommendations for rehabilitation teams caring for them.…”

Retrospective study of rehabilitation outcomes following spinal cord injury due to tumour

“…5,6 Previous reports on their rehabilitation outcomes have been published. [7][8][9][10] These patients can have a relatively short survival, 11,12 and have a peak age at the time of diagnosis of between 50 and 70 years. 13 With the ageing population and improvements in early cancer diagnosis and treatment leading to increased survival, the number of patients with SCI due to tumour with the potential to benefit from rehabilitation is increasing.…”