Page 66 - Predicting survival in patients with spinal bone metastasesL

CHAPTER IV
Even though neurological status is one of the most important factors to consider when deciding on treatment, the presence of neurological deficit at the start of treatment does not directly influence survival in any of the three clinical profiles described in this study. Rades et al. have shown that the time of developing motor deficits is the most important factor predicting improvement of neurological functioning after treatment24. Neurologic status should therefore be viewed as an indication for treatment, rather than a predictive factor when estimating survival. Especially in the case of sudden paraplegia due to spinal cord compression, swift and decisive treatment is far more important than estimation of survival, as the possible benefits of treatment in terms of quality of life far outweigh the possible risks in terms of a short remaining lifespan. When assessing neurological deficit in patients with SBM, the Frankel classification might not be the most suitable tool, as it was originally designed for categorizing spinal cord injury only. Neurological symptoms caused by nerve root compression or compression of the cauda equina are not covered, necessitating the development of a SBM-specific classification for describing neurological deficit.
Figure 4. Flowchart for stratification.
Even though the number and location of SBM influence treatment options such as possibilities of surgical fixation and range of radiation fields, they did not show a significant effect on survival. Sixty-nine percent of all studied patients had more
64