Metastatic and traumatic spinal cord injury: Acute rehabilitation outcome, post-discharge placement, and one year survival

Paraplegia following metastatic spinal damage is associated with specific problems that require expert attention and management. Out of 744 consecutive admissions to a Spinal Cord Injury Unit, the acute rehabilitation outcomes, the post-discharge placements, and the one-year survival rates of twenty patients with metastatic spinal cord lesions (MSCL) were compared to twenty-four patients with traumatic spinal cord injury (TSCI) in the same age range and level of neurologic injury. The rehabilitation outcome was measured using the Functional Independence Measure scores, the efficiency and the efficacy scores, and the length of stay in the inpatient rehabilitation unit. Although the average FIM scores at admission were higher in the MSCL group (70 vs. 65.63), their discharge FIM scores were lower than in the TSCI group (88.28 vs. 96.1). The efficacy score was significantly worse in the MSCL group (p = 0.01) and there was no significant difference in efficiency between both groups. The median length of stay was shorter in the MSCL group (33.09 vs. 48.74 days), but they were much less likely to be discharged home (55% vs. 83.3%); the remaining MSCL patients went to acute or chronic hospitals or to a hospice. A one-year followup of fourteen patients of the MSCL group showed a 21.4% survival rate, while all eighteen patients of the TSCI group survived. Our findings suggest the need for a reviewed approach in the rehabilitation of this population.