Epidural metastatic spinal cord compression: Functional outcome and survival after inpatient rehabilitation

Abstract

Study design: Retrospective descriptive study. Objectives: (1) To obtain an overall appraisal of patients with epidural metastatic spinal cord compression (SCC) admitted to nine Dutch spinal cord units (SCUs) between 01-01-1990 and 01-01-2000. (2) To identify factors that predict survival > 1 year after in-patient rehabilitation of patients with epidural metastatic SCC. Setting: Dutch SCUs. Rehabilitation Center Amsterdam, Amsterdam. Rehabilitation Center Heliomare, Wijk aan Zee. Rehabilitation Center De Hoogstraat, Utrecht. Rehabilitation Center Rijndam, Rotterdam. Rehabilitation Center Sophia Stichting, Den Haag. Rehabilitation Center Beatrixoord, Haren. Rehabilitation Center Het Roessingh, Enschede. Rehabilitation Center Sint Maartenskliniek, Nijmegen. Rehabilitation Center SRL Hoensbroeck, Hoensbroek. Methods: (1) Clinical records were reviewed and demographic, clinical and functional data were collected according to a protocol. The date of admittance to the SCU, rehabilitation goals, date of discharge and date of death were recorded. (2) The odds ratio (OR) was calculated for all determinants on admittance to the SCU in order to find indicators that predict survival > 1 year after discharge from the SCU. An OR ≥2 was considered to be clinically significant. Results: In total, 131 patients with epidural metastatic SCC were admitted. In all, 117 clinical records were retrieved and 97 clinical records provided complete data. The average age on admittance was 58 years. Among the patients 53% were male. The average Barthel score on admittance was 7.2/20 points. The average length of stay in the SCU was 104 days (3-336). Overall, 66% of the patients were discharged. The average Barthel score on discharge was 12.0 points. The average survival after discharge was 808 (0-3669) days. During their stay on the SCU, seven patients died. At 1 year after discharge, 52% of the patients were still alive. These patients suffered less complications, had been admitted less often to a hospital during rehabilitation, had made better functional progress and had been discharged home more often, A survival > 1 year after discharge is related to ASIA D (OR 4.3), MRC 4 and 5 (OR 5.4), tumour in remission (OR 3.8) and independence or partial independence on the Barthel items: dressing (OR 4.3) and making transfers (OR 5.0). Conclusions: Patients with epidural metastatic SCC may benefit from in-patient rehabilitation.