Surgical Results and its Prognostic Factors on Motor Deficit in Patients with Spinal Cord Compression from Metastatic or Primary Bone Tumors

Park, Sang Woo; Jeon, Sang Ryong; Park, Jun Bum; Roh, Sung Woo; Rhim, Seung Chul; Lee, Jeong Kyu

Abstract

OBJECTIVE
Spinal cord compression (SCC) is a disabling complication of metastatic and malignant primary bone tumors. The aim of this study is to estimate sugical results and its prognostic factors on motor deficit in patients with SCC.
METHODS
Between 1997 and April 2005, 22 consecutive patients with SCC (above L1) due to metastatic and malignant primary bone tumor underwent surgery. The medical records and radiological studies of patients were reviewed retrospectively. Also, we analyzed perioperative radiation, type of metastatic cancer, duration from weakness to surgery, use of steroid, preoperative and postoperative motor weakness, type of cord compression.
RESULTS
In 33 patients treated for metastatic or primary bone tumor at our institution, 22 (67%) cases presented with motor deficit from SCC. The median age was 56 years and there was preponderance of males (73%). Metastasis from lung cancer (40%) was predominant and primary bone tumor was 2 (9%) cases. Before treatment, 9% had grade 0, 5% grade 1, 32% grade 2, 27 % grade 3, and 27% grade 4 paresis. All underwent surgical treatment and received steroid. 14 of them underwent perioperative radiation. Dorsal (45%) or ventral (23%) compression of spinal cord was dominant. The mean duration of motor weakness before surgical treatment was 10.2 days. There is a possibility that urgent decompression showed better prognosis for ambulation. 20 cases (91%) showed improvement of motor grade. 2 cases which showed no improvement in motor function died from postoperative medical problem during hospital stay. 17 (85%) of 20 cases who showed postoperative motor improvement were ambulatory. 12 (75%) of 16 cases who were non-ambulatory represent postoperative ambulation. Postoperative recovery of motor function were not realated with type of cancer, method of surgery, type of compression and radiation. Prognostic factor of postoperative ambulation was preoperative motor grade and urgent decompression in author's study.
CONCLUSION
Most(91%) cases who underwent decompressive surgery showed motor improvement postoperatively. Decompressive surgical intevention was exellent treatment of modality to recover motor deficit in patients with SCC. Prognostic factor of postoperative ambulation was preoperative motor grade in this study. All patients with preoperative motor grade III showed ambulation postoperatively, and patients with Grade III improved in 42.9%. Therefore, the authors suggest aggressive surgery is needed before the patients with spinal metastasis aggravate their motor function.