Postacute management of patients with spinal cord injury due to metastatic tumour disease: survival and efficacy of rehabilitation.

STUDY
DESIGN: Retrospective study utilising clinical records and public administration databases.
OBJECTIVES: This study was performed to analyse the clinical presentation and survival rate of individuals with spinal cord injury (SCI) due to spinal metastasis after primary treatment, and to evaluate the efficacy of rehabilitative efforts.
SETTING: Spinal Cord Injury Unit, University Hospital, Heidelberg.
METHODS: A total of 68 consecutive patients were included. Demographics, clinical data, tumour type, level and completeness of SCI, initial treatment, functional independence measure (FIM) and survival time were derived from hospital and public administration databases. Cox regression and fuzzy logic rule generation were used for statistical analysis.
RESULTS: Of the 68 patients, 66 patients died 11 months (median, interquartile range (IQR) 4-29 months) after the onset of neurological symptoms at an average age of 58 years. The functional independence measure (FIM) score describing the general clinical and functional status proved to be the most reliable prognostic factor of survival. Other more specific parameters (eg tumour type or level of lesion) did not have such an impact. In total, 51 patients completed the rehabilitation programme within 50 days (median, IQR 27-99 days). The FIM score improved from 62 at admission to 84 at discharge.
CONCLUSION: The clinical and functional status is a valuable prognostic factor for survival. Since institutionalised rehabilitative efforts are effective, this group of patients should be accepted into such a program.