Early Phase Functional Recovery after Spinal Intramedullary Tumor Resection Could Predict Ambulatory Capacity at 1 Year after Surgery

Asian Spine Journal, 2023 · DOI: 10.31616/asj.2022.0068 · Published: April 1, 2023

Simple Explanation

This study aimed to examine the short-term course of physical function and walking ability in patients with intramedullary spinal cord tumors (ISCTs) in the early postoperative period. The goal was to predict the ambulatory state 1 year after surgery and assist in planning long-term postoperative rehabilitation. The study found that patients with better lower-limb function scores in the early phase are more likely to have improved walking ability 1 year after ISCT resection.

Study Duration

2014-2019

Participants

79 independent ambulatory preoperative cases

Evidence Level

Not specified

Key Findings

1
71% and 43% of participants were nonindependent ambulators at 1 week and 2 weeks postoperatively, respectively.
2
Patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1 week and 2 weeks than those with vascular tumors.
3
A WISCI II score of 2 points at 2 weeks postoperatively had high sensitivity (100%) and specificity (92.2%) in predicting walking independence at 1 year.

Research Summary

The study evaluated postoperative functional status using FIM-L, WISCI II, ASIA-LEMS, and ASIA-LESS scores, finding that independent walkers at 2 weeks had better lower-limb and sensory function recovery at 1 week. Those with solid tumors had lower walking ability and sensory function than those with vascular tumors, potentially due to differences in surgical approaches. The cutoff value of the WISCI II score at 2 weeks was 2 points to predict recovery of walking ability as an independent ambulator at 1 year postoperatively.

Practical Implications

Rehabilitation Strategies

An earlier start of postoperative rehabilitation for ISCTs is necessary to strengthen lower-limb muscles and practice repetitive movements.

Surgical approach

Surgical approach should be tailored considering tumor histology to minimize damage to sensory pathways.

Prognostic Indicator

WISCI II score at 2 weeks post-op can predict walking independence at 1 year.

Study Limitations

1
Evaluation for sensory function was not enough, especially for position sense and deep sensation.
2
Postoperative myelopathic pain should also be considered.
3
Assessment of motor function was exclusively limited to lower-limb functions.

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