According to the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) developed by the World Health Organization, impairment refers to a problem associated with a bodily structure or organ, whereas disability refers to a functional limitation in a particular activity [1]. Cancer patients suffer from a set of impairments, partially due to the disease itself, and partly due to the adverse effects of treatment. Both physical and psychological impairments contribute to decreased quality of life which may result in disability. Recently, many researchers have demonstrated that cancer rehabilitation improves physical impairments at every stage along the treatment course for a variety of cancer types [2–5].
Impairment-driven cancer rehabilitation is a model advocated by Silver et al. since 2013. They emphasized the importance of identifying physical impairments because disability is frequently driven by the interactions of multiple physical impairments. Therefore, this model involves screening and treating impairments all throughout the course of care to minimize disability and maximize the quality of life [6].
Among the different impairments in cancer patients, neoplastic spinal compression is unique because the severity of impairment (or of disability) does not correlate with the pathological grade of malignancy. The impairment is neurological-oriented [7–9]; it is only associates with spine-specific factors which are the level of spinal cord injury and the volume of spinal compression. Thus, we assume that disability from neoplastic spinal compression can be prevented with appropriate interventions aimed to treat these spine-specific factors and such interventions would be effective even in patients at the palliative stage.
Clinically, we evaluated the spine-specific factors based on two independent biological aspects: skeletal instability and tumor growth. Skeletal instability is caused by the destruction of bony structures. A pathological fracture may occur and fragments in the spinal canal may cause paraplegia. In terms of tumor growth, the volume of rapidly-growing tumors in the spinal canal may threaten the spinal cord directly, even if skeletal stability was preserved. Regarding surgical approaches, wide resection has been considered the curative treatment because both local and marginal resection may result in higher rates of recurrence. This is why conservative surgeries for local control have rarely been performed for these patients [10–11]. However, to treat skeletal instability, some surgical approaches have been reported [12–15].
Minimally invasive spine stabilization (MISt) with percutaneous pedicle screws (PPS) have shown advantages of relatively lower blood loss, less morbidity, shorter hospital stays, lower postoperative infections and immediate mobilization without the need for external bracing [13–15]. Several studies have reported improved activities of daily living (ADL) after MISt with PPS as a palliative surgery for patients with neoplastic spinal cord compression [13–15]. However, since most studies lack the impairment-driven approach, surgical indications still remain unclear.
In this study, we retrospectively reviewed 27 consecutive patients with neoplastic spinal compression who were treated with MISt and received immediate rehabilitation thereafter. Before the surgery, the status of impairment was evaluated based on both spine-specific factors and other factors. The neurological deficit, ambulation status, progress of pathological fracture, collapse, postoperative implant failure were examined. Furthermore, the relationship between the improvement of Barthel index (BI) [16] and prognosis was statistically analyzed.