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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 2, 240-244.
doi: 10.1302/0301-620X.91B2.20894  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The effect of early surgical treatment on recovery in patients with metastatic compression of the spinal cord

C. H. Fürstenberg, MD, Consultant Orthopaedic Surgeon1; B. Wiedenhöfer, MD, Senior Consultant Orthopaedic Surgeon1; H. J. Gerner, MD, PhD, Head of Department1; and C. Putz, MD, Resident1

1 Orthopaedic University Hospital Heidelberg, Schlierbacher Landstrasse 200a, D-69118 Heidelberg, Germany.

Correspondence should be sent to Dr C. H. Fürstenberg; e-mail: carl.hans.fuerstenberg{at}ok.uniheidelberg.de

We analysed the influence of the timing of surgery (< 48 hours, group 1, 21 patients vs > 48 hours, group 2, 14 patients) on the neurological outcome and restoration of mobility in 35 incomplete tetra- and paraplegic patients with metastatic spinal-cord compression.

Pain and neurological symptoms were assessed using the American Spinal Injury Association impairment scale. More improvement was found in group 1 than in group 2 when comparing the pre-operative findings with those both immediately post-operatively (p = 0.021) and those at follow-up at four to six weeks (p = 0.010). In group 1 the number of pre-operatively mobile patients increased from 17 (81%) to 19 patients (90%) whereas the number of mobile patients in group 2 changed from nine (64%) to ten (71%).

These results suggest that early surgical treatment in patients with metastatic spinal-cord compression gives a better neurological outcome even in a palliative situation.




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Another 48 hours
Andrew Clarke, et al.
J Bone Joint Surg Br Online, 20 Feb 2009 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General