Factors related to the outcome of inpatient rehabilitation in patients with neoplastic epidural spinal cord compression.

In this study we have tried to develop a method to predict the survival and the functional outcome following neoplastic spinal cord injury (SCI), which can be helpful when selecting patients for an intensive inpatient rehabilitation programme. We reviewed the clinical records of all patients with neoplastic epidural spinal cord compression, admitted to any Dutch spinal cord unit (SCU) between 1-1-1985 and 1-1-1990 (n = 74). According to the outcome on 1-1-1991 the average stay at the SCU was 111 days, whereas the average survival after discharge was 423 days. Seven patients died during their stay. Of all of the factors analysed, six showed a positive relationship with prolonged survival (> one year after discharge) and improved functional level: tumour biology (lymphoma, myeloma, breast and kidney tumours); SCI as the presenting symptom of the malignancy; slow (> 1 week) progression rate of neurological symptoms; tumours treated with a combination of surgery and radiotherapy; (partial) bowel control at admission; and (partial) independence regarding transfer activities at admission. A sum score (range 0-6) of these indicators is introduced. A patient with a sum score of 0-1 has zero probability of living longer than one year after discharge and 0.19 of functional improvement during stay at the SCU. A score of 5-6 yields probabilities of 0.77 and 0.92 respectively. We conclude that the sum score can be helpful when selecting patients for an intensive inpatient rehabilitation programme or modifying such a programme. Validation for application in a general hospital is needed.