Challenge or opportunity: Rehabilitation outcomes in patients with metastatic spinal cord compression – a UK single center experience

Abstract

Context /Objective

Metastatic Spinal Cord Compression (MSCC) is a devastating complication of cancer, affecting approximately 3000 patients per annum in England. However, access to rehabilitation services for MSCC patients is limited. The London Spinal Cord Injury Centre has set up a bespoke MSCC rehabilitation pathway from May 2013. This article aims to describe the clinical features and functional outcomes of patients with MSCC admitted to a Specialist Spinal Cord Injury Rehabilitation Centre between May 2013 and December 2021.

Design

Retrospective analysis of medical records from a single specialist rehabilitation centre database.

Setting

London Spinal Cord Injury Centre (LSCIC), Stanmore, United Kingdom.

Participants

Adult patients diagnosed with MSCC who were admitted to and discharged from LSCIC from May 2013 to December 2021.

Interventions

Specialist Inpatient Spinal Cord Injury Rehabilitation Program.

Outcome Measures

Spinal Cord Independence Measure 19 (SCIM version III), Discharge Destination.

Results

A total of 40 patients with MSCC were admitted – 32 male and 8 female patients. The average length of stay was 6 weeks. 17(42.5%) patients had primary prostate cancer. Most patients (34(85%)) had thoracic MSCC. There was an improvement in the Spinal Cord Independence Measure in all patients with an average significant improvement from 43.8 to 64.5 (P < 0.001). There was no significant difference in SCIM scores between patients under 65 and over 65. 28 (70%) patients required psychological input. 33(82.5%) patients were discharged home.

Conclusion

Patients with MSCC show improvement in SCIM outcome measures after a six-week inpatient Specialist Spinal Rehabilitation program.

Keywords:

• Spinal cord injury
• Extramedullary
• Spinal cord compression
• Metastases
• Rehabilitation
• Outcome assessment

Acknowledgements

We would like to thank all the staff of the London Spinal Cord Injury Centre Outreach team especially Catherine Godfrey, Natasha Wallace, Rosa Castro and to all the LSCIC Case Managers who assisted with the provision of invaluable data for this project.

Disclaimer statements

Contributors None

Funding None.

Conflicts of interest All authors have no conflicts of interests to declare.

Author contributions

• Dr Manish Desai conceptualized the idea for this analysis and assisted with editing the script.

• Dr Gisele Lafeuillee was responsible for planning, and execution of the study. She was also responsible for the data collection, presentation, and submission of the manuscript and for coordinating editing process.

• Francesco Magni shared writing of the initial draft of the Introduction, contributed to the data-collection and editing the script.

• Dr Sarah Knight assisted with statistical analysis of the results and with editing the script.