Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression

Publication date: July 2018

Source: The Spine Journal, Volume 18, Issue 7

Author(s): Eyal Itshayek, Carlos Candanedo, Shifra Fraifeld, Amir Hasharoni, Leon Kaplan, Josh E. Schroeder, José E. Cohen

Abstract

Background and Context

Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore or preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management.

Purpose

Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC.

Study Design/Setting

Retrospective file review of a prospective database, under institutional review board (IRB) waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from August 2008 to March 2015.

Patient Sample

Patients ≥65 years presenting neurological and/or radiological signs of cord compression because of metastatic disease, who underwent surgical decompression.

Outcome Measures

Duration of ambulation and survival.

Methods

Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared 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-Meier analysis.

Results

Forty patients were included (21 male, 54%; mean age 74 years, range 65–87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0–1662) and 525 days (range 11–1662), respectively; 53% of patients (21 of 40) survived and 43% (17 of 40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65–69, 70–79, or 80–89 years, although Kaplan-Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=.0342, p=.0358, respectively) and postoperative KPS (p=.0221). Tokuhashi score was not significantly related to duration of survival or ambulation, and greatly underestimated life expectancy in 22 of 37 (59%) patients with scores 0–11.

Conclusions

Decompressive surgery led to marked improvement in neurological function and performance status. More than 50% of patients survived for >1 year, some for 3 years or more after surgery.

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