Itshayek E, et al. - This study was performed to assess the duration of ambulation and survival in elderly patients who underwent surgical decompression of metastatic epidural spinal cord compression (MESCC). Marked improvement in neurological function and performance status was reported subsequent to decompressive surgery. More than 1-year survival was reported in over 50% of patients, some survived for 3 years or more after surgery.

Methods

• Researchers retrospectively reviewed a prospective database, under IRB waiver of informed consent, including consecutive patients treated in an academic tertiary care medical center from 8/2008–3/2015.
• Study participants included patients ≥65 years presenting neurological and/or radiological signs of cord compression due to metastatic disease, who underwent surgical decompression.
• Duration of ambulation and survival were included as outcome measures.
• Patients underwent urgent multidisciplinary evaluation and surgery.
• Furthermore, they compared ambulation and survival with age, pre- and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS], and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed-rank tests, Pearson correlation coefficient, Cox regression model, log rank analysis, and Kaplan Meir analysis.

Results

• This study included a total of 40 patients (21 male, 54%; mean age 74 years, range 65–87).
• According to data, surgery was performed a mean 3.8 days after onset of motor symptoms.
• The reported mean duration of ambulation and survival were 474 (range 0–1662) and 525 days (range 11–1662), respectively; 53% of patients (21/40) survived and 43% (17/40) retained ambulation for ≥1 year.
• Researchers found that for patients aged 65–69, 70–79, or 80–89, survival and ambulation were not significantly correlated, although Kaplan Meier analysis suggested stratification.
• They noted a significant link between duration of ambulation and pre- and postoperative AIS (p=0.0342, p=0.0358, respectively) and postoperative KPS (p=0.0221).
• In addition, data highlighted no significant association of the Tokuhashi score with duration of survival or ambulation, and greatly underestimated life expectancy in 22/37 (59%) patients with scores 0–11.