Resumption of ambulation significantly affected by motor grade, occurrence of a major complication
FRIDAY, Dec. 2 (HealthDay News) -- The majority of nonambulatory patients with epidural spinal metastasis become ambulatory postoperatively, according to a study published in the November issue of The Spine Journal.
Chi Heon Kim, M.D., Ph.D., from the Seoul National University Hospital in South Korea, and colleagues investigated the surgical outcome and probability of ambulatory resumption in 57 patients with epidural spinal metastasis, who could not ambulate independently at the time of surgery (between 1987 and 2010). A total of 21 and 36 patients had a preoperative functional status of Nurick Grade 4 and 5, respectively. Participants developed weakness 10.5 ± 11.9 days preoperatively (median, 7.0 days). The weakness deteriorated steadily, and patients were unable to walk starting from 3.6 ± 4.9 days preoperatively (median, 1.8 days). Postoperative ambulatory status and survival were the primary and secondary end points of the study, respectively.
The investigators found that 68 percent of the patients could walk postoperatively. In 26 percent of patients, there were complications, with major complication and mortality rates of 12 and 5 percent, respectively. After the operation, the patients survived 287 ± 51 days (median, 128); and survival was influenced by postoperative ambulatory status and occurrence of major complications. Postoperatively, the patients could walk for 193 ± 41 days (median, 114). Resumption of ambulation was significantly influenced by motor grade and the occurrence of a major complication. The rate of ambulation resumption was 95 and 53 percent in patients with a motor grade of 4 of 5, and less than 4 of 5, respectively.
"The survival time of nonambulatory patients with epidural spinal cord compression depends on ambulatory recovery," the authors write.
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