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The timing of surgical intervention in the treatment of complete motor paralysis in patients with spinal metastasis

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Abstract

Purpose

The timing of surgical intervention is important for ambulatory patients with metastatic epidural spinal cord compression (MESCC), while limited studies have focused on non-ambulant patients. The aim of this study was to investigate the proper timing of surgical intervention for paraplegic patients with MESCC.

Methods

Forty-three non-ambulant patients with MESCC who underwent posterior decompression were retrospectively reviewed. The neurological outcomes for pre-operative Frankel B patients with different interval window were further compared.

Results

Neurologic deficit improved by at least 1 Frankel grade in 37 patients who underwent surgery within 72 h (86.0 %). Overall, 18 pre-operative Frankel B patients became ambulatory again with an interval of less than 48 h, 15 pre-operative Frankel B patients remained non-ambulatory post-operatively with an interval longer than 48 h besides one with an interval of 8 h (P < 0.001). All nine pre-operative Frankel A patients remained non-ambulatory even though the interval window was less than 24 h.

Conclusion

The timing of surgical intervention was key to predicting the post-operative outcome, and 48 h was suggested as the proper interval window for pre-operative Frankel B patients. These patients preserved sensory function which might be a predictor. And the sooner the surgery was performed, the better the result would be.

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Authors and Affiliations

  1. Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China

    Yu Fan, Xi Zhou, Hai Wang, Pengxiang Jiang, Siyi Cai, Jianguo Zhang & Yong Liu

  2. No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, People’s Republic of China

    Yong Liu

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  1. Yu Fan
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  2. Xi Zhou
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  3. Hai Wang
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  5. Siyi Cai
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  6. Jianguo Zhang
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  7. Yong Liu
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Correspondence to Yong Liu.

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Fan, Y., Zhou, X., Wang, H. et al. The timing of surgical intervention in the treatment of complete motor paralysis in patients with spinal metastasis. Eur Spine J 25, 4060–4066 (2016). https://doi.org/10.1007/s00586-016-4406-7

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  • DOI: https://doi.org/10.1007/s00586-016-4406-7

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