PURPOSE: We aimed to identify predictors of ambulation recovery in patients who lost their ability to walk for more than 48 h due to metastatic spinal cord compression (MSCC).

METHODS: This was a retrospective cohort study of 121 patients with MSCC who underwent surgery. The primary outcome variable was postoperative ambulatory status. The secondary outcome variable was postoperative survival in relation to restored ambulation. Age, primary tumor grade, MSCC anatomical location, Karnofsky performance status (KPS), Charlson comorbidity index, neurological deterioration speed, MSCC grade according to the epidural spinal cord compression scale, anal sphincter tonus and hip flexion strength before surgery, and postoperative complications were analyzed as predictive variables.

RESULTS: One month after surgery, ambulation was restored in 61 of the 111 patients (55%), 10 patients died within one month after surgery. Primary tumor grade (p = 0.03), hip flexion strength before surgery (p < 0.001), and postoperative complications (p = 0.001) were associated with ambulation recovery. The accuracy of hip flexion strength as a predictor was analyzed with a receiver operating characteristic (ROC) curve, with an area under the curve of 0.74 (p < 0.001). The median postoperative survival of patients who regained ambulation was 16 months, whereas that of patients who lost walking ability was 5 months (p = 0.004). According to the multiple Cox regression model, KPS (p < 0.001) and ambulation after surgery (p = 0.027) were predictors of postoperative survival.

CONCLUSIONS: Primary tumor grade, hip flexion strength before surgery, and surgical complications affect neurological recovery in MSCC patients who had lost their ability to walk for more than 48 h.