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Research ArticleClinical Studies

Predictors of Postoperative Gain in Ambulatory Function After Decompressive Surgery for Metastatic Spinal Cord Compression

HIDEYUKI KINOSHITA, HIROTO KAMODA, YOKO HAGIWARA, SEIKO KINOSHITA, SEIJI OHTORI and TSUKASA YONEMOTO
Anticancer Research April 2023, 43 (4) 1767-1773; DOI: https://doi.org/10.21873/anticanres.16330
HIDEYUKI KINOSHITA
1Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan;
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  • For correspondence: kinoshi1783@yahoo.co.jp
HIROTO KAMODA
1Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan;
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YOKO HAGIWARA
1Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan;
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SEIKO KINOSHITA
2Laboratory of Oncogenomics, Chiba Cancer Center Research Institute, Chiba, Japan;
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SEIJI OHTORI
3Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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TSUKASA YONEMOTO
1Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan;
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Abstract

Background/Aim: Reports on the effects of timing of the surgery on the patient survival rate or the results of palliative laminectomy are limited. The aim of the study was to investigate the postoperative ambulatory status of neurologically impaired metastatic spinal cord compression (MSCC) patients who underwent laminectomy and evaluate predictors of postoperative ambulation recovery after laminectomy for MSCC. Patients and Methods: We included 175 patients who underwent decompressive surgery for MSCC. Changes in the Frankel grade (FG) were evaluated perioperatively. Among all patients, 113 were unable to walk preoperatively and were divided into two groups: 70 and 43 patients in the ambulation-regained and ambulation-not regained postoperatively groups, respectively. The percentage of patients eligible for postoperative chemotherapy and overall survival rate in each group were investigated. Furthermore, predictors of postoperative ambulation recovery after laminectomy for MSCC were examined. Results: The most common primary tumor sites were the lung, prostate, and breast. FG improved with surgery in 80 cases, remained unchanged in 94 cases, and worsened in one case. In the ambulation-regained group, 70% were eligible for postoperative chemotherapy, while only 26% of the not-regained group were eligible for postoperative chemotherapy. The postoperative survival rate of the ambulation-regained group was significantly better than that of the not-regained group. Univariate predictors for not regaining the ability to walk were Karnofsky Performance Status ≤40 prior to surgery, FG B prior to surgery, and time to surgery since the inability to walk >48 h. Conclusion: Decompressive surgery benefits motor function postoperatively. Both good neurological status prior to surgery and prompt surgery for non-ambulatory MSCC are important predictors of improved functional outcome.

Key Words:
  • Metastatic spinal cord compression (MSCC)
  • decompressive surgery
  • ambulation recovery
  • survival rate
  • Received December 18, 2022.
  • Revision received January 1, 2023.
  • Accepted January 16, 2023.
  • Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Anticancer Research: 43 (4)
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April 2023
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Predictors of Postoperative Gain in Ambulatory Function After Decompressive Surgery for Metastatic Spinal Cord Compression
HIDEYUKI KINOSHITA, HIROTO KAMODA, YOKO HAGIWARA, SEIKO KINOSHITA, SEIJI OHTORI, TSUKASA YONEMOTO
Anticancer Research Apr 2023, 43 (4) 1767-1773; DOI: 10.21873/anticanres.16330

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Predictors of Postoperative Gain in Ambulatory Function After Decompressive Surgery for Metastatic Spinal Cord Compression
HIDEYUKI KINOSHITA, HIROTO KAMODA, YOKO HAGIWARA, SEIKO KINOSHITA, SEIJI OHTORI, TSUKASA YONEMOTO
Anticancer Research Apr 2023, 43 (4) 1767-1773; DOI: 10.21873/anticanres.16330
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Keywords

  • Metastatic spinal cord compression (MSCC)
  • decompressive surgery
  • ambulation recovery
  • survival rate
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