Postoperative Survival and Ambulatory Outcome in Metastatic Spinal Tumors : Prognostic Factor Analysis

OBJECTIVE: The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. METHODS: We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. RESULTS: The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). CONCLUSION: Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.

Outcome of Percutaneous Vertebroplasty Assessed by Ambulatory Scale in Patients with Osteoporotic Vertebral Compression Fractures

OBJECTIVE: The purpose of this study is to evaluate the outcome of percutaneous vertebroplasty based on the ambulatory scale, classified at our institution, and to determine the factors influencing on prognosis of vertebroplasty. METHODS: We retrospectively reviewed a consecutive patients undergoing percutaneous vertebroplasty between June 1999 and December 2001. A total of 151 patients underwent percutaneous vertebroplasty. We investigated the effects of clinical and radiological variables on ambulatory outcome of percutaneous vertebroplasty. RESULTS: Ambulatory status was improved in 94.7% and 88.7% of the patients at postoperative 1 day and last follow-up, respectively. Symptom duration, the remain of vertebral body height, the level and numbers of procedure, the amount of PMMA and presence of PMMA leakage did not influence on the ambulatory outcome of vertebroplasty(p>0.05). A stepwise logistic regression analysis demonstrated that preoperative ambulatory score and the severity of osteoporosis were important prognostic factors at postoperative 1 day, while only the patients' age was a significant prognostic factor at last follow-up, in patients with osteoporotic compression fractures. CONCLUSION: Percutaneous vertebroplasty can be an effective treatment modality for improvement in ambulatory status in patients with osteoporotic vertebral compression fractures, especially when the osteoporosis is severe and preoperative ambulatory score is low. At long term follow-up, only patients' age has an important prognostic value.