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 surviva l and the functional outcome following neoplastic spinal cord injury ( SCI), which can be helpful when selecting patients for an intensive in patient rehabilitation programme. We reviewed the clinical records of all patients with neoplastic epidural spinal cord compression, admitte d 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 S CU was 111 days, whereas the average survival after discharge was 423 days. Seven patients died during their stay. Of all of the factors ana lysed, six showed a positive relationship with prolonged survival (> o ne 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 neurol ogical symptoms; tumours treated with a combination of surgery and rad iotherapy; (partial) bowel control at admission; and (partial) indepen dence 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 t hat the sum score can be helpful when selecting patients for an intens ive inpatient rehabilitation programme or modifying such a programme. Validation for application in a general hospital is needed.