Prognostic Factors of Ambulatory Status for Patients with Metastatic Spinal Cord Compression: A Systematic Review and Meta-Analysis

Background: This study aimed to identify prognostic factors for functional outcome of metastatic spinal cord compression (MSCC).

Methods: All full texts in English regarding the prognostic factors for functional outcome of MSCC, published between January 2007 and October 2017, were identified using the electronic databases PubMed, Embase, and the Cochrane Library. An exploratory meta-analysis was also conducted when appropriate data were available.

Results: A total of 25 studies, involving 4897 patients, met the inclusion criteria. Overall, 69.7% of patients across all studies were able to walk postoperatively compared with 49.0% preoperatively. Moreover, 84.7% of the patients maintained ambulation after treatment. Motor function was significantly associated with ambulatory status before treatment, time of developing motor deficits, interval from symptom to surgery, and preoperative performance status.

Conclusions: Ambulatory status before treatment, interval from symptom to treatment, and time of developing motor deficits can be considered as the most significant prognostic factors for posttreatment ambulatory status. Spinal metastasis should have a higher priority, and immediate intervention should be started before the development of irreversible neurologic deficits. Moreover, short-course radiotherapy might be a good option for patients with a limited life span. Consequently, the identified prognostic factors can be regarded as a preoperative assessment tool to predict neurologic outcome and guide clinical treatment for individual patients with MSCC. However, the retrospective nature of this study with low-quality evidence must be taken into account when interpreting these results, and further research is needed to identify prognostic factors.