Prediction of Postoperative Ambulatory Function Using Nomogram in Patients with Metastatic Epidural Spinal Cord Compression.
- 1Department of Spine Care, King Abdullah Medical City, Makkah 24246, Saudi Arabia.
- 2Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Abstract
Background/Objectives: This study was conducted to develop and internally validate a nomogram that predicts postoperative ambulatory function in patients with metastatic epidural spinal cord compression (MESCC) undergoing decompressive surgery. Methods: Of 352 patients who underwent surgery for metastatic spinal cancer at a single tertiary center between 2014 and 2021, 97 with MESCC (Bilsky grade 2-3) and preoperative neurological deficits (ASIA grade D or worse) were included in this retrospective study. Binary logistic regression was used to identify candidate predictors of 3-month postoperative ambulatory status in the full cohort (p < 0.10 in univariable analysis), which were then entered into a multivariable logistic regression model and incorporated into a nomogram using the rms package in R. Model discrimination and calibration were internally validated using Harrell's bootstrap optimism-correction method with 1000 resamples. Results: Postoperative ambulation was regained in 24 patients (24.7%). Four variables met the prespecified threshold (p < 0.10) for inclusion in the nomogram: preoperative motor grade (OR 2.48; 95% CI 1.41-4.34; p = 0.002), symptom onset-to-operation interval (OR 0.81; 95% CI 0.62-1.04; p = 0.098), preoperative KPS (OR 1.04; 95% CI 1.00-1.07; p = 0.070), and age (OR 0.97; 95% CI 0.93-1.01; p = 0.087); in the multivariable model, only preoperative motor grade and symptom onset-to-operation interval were independently associated with ambulatory recovery (p < 0.05). The nomogram achieved an apparent AUC of 0.827 (optimism-corrected, 0.800) and acceptable-to-good calibration (optimism-corrected calibration slope, 0.848; intercept, -0.088). At the Youden-optimal threshold, apparent (optimism-corrected) sensitivity, specificity, and F1 score were 79.2% (74.5%), 78.1% (76.7%), and 64.4% (60.6%), respectively. Conclusions: The nomogram demonstrated acceptable discrimination and good calibration for predicting postoperative ambulation in patients with MESCC. This tool may support individualized surgical decision-making and patient counseling. External validation is required before routine clinical use.
Related
- Quantitative Spinal Cord Deformation Is Associated with Neurologic Status in High-Grade Thoracic Metastatic Epidural Spinal Cord Compression: A Retrospective Surgical Cohort.
- Metastatic Lung Cancer to Non-vascular Soft Tissue and Lumbar Spine Mimicking Postoperative Scar at L4-5 Non-union: A Case Report.
- Influence of the initial recurrence and metastatic site on outcomes in postoperative gastric cancer patients
- Prognostic significance and clinicopathologic prediction of tumor deposits in non-metastatic colon mucinous adenocarcinoma
- Multi-modal data Integration for Metastatic Risk Prediction of AJCC Stage I/II Melanomas: Results from the Population-based Dutch Early-stage Melanoma Study (D-ESMEL)
BibTeX
@article{alayed2026prediction,
title = {{Prediction of Postoperative Ambulatory Function Using Nomogram in Patients with Metastatic Epidural Spinal Cord Compression.}},
author = {Ibrahim S Alayed and Sehan Park and Dong-Ho Lee and Chang Ju Hwang and Sung Tan Cho and Jae Hwan Cho},
journal = {Journal of clinical medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197459},
url = {https://europepmc.org/article/MED/42881920},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prediction of Postoperative Ambulatory Function Using Nomogram in Patients with Metastatic Epidural Spinal Cord Compression.
AU - Ibrahim S Alayed
AU - Sehan Park
AU - Dong-Ho Lee
AU - Chang Ju Hwang
AU - Sung Tan Cho
AU - Jae Hwan Cho
PY - 2026
DA - 2026/09/25
JO - Journal of clinical medicine
DO - 10.3390/jcm15197459
UR - https://europepmc.org/article/MED/42881920
AB - Background/Objectives: This study was conducted to develop and internally validate a nomogram that predicts postoperative ambulatory function in patients with metastatic epidural spinal cord compression (MESCC) undergoing decompressive surgery. Methods: Of 352 patients who underwent surgery for metastatic spinal cancer at a single tertiary center between 2014 and 2021, 97 with MESCC (Bilsky grade 2-3) and preoperative neurological deficits (ASIA grade D or worse) were included in this retrospective study. Binary logistic regression was used to identify candidate predictors of 3-month postoperative ambulatory status in the full cohort (p < 0.10 in univariable analysis), which were then entered into a multivariable logistic regression model and incorporated into a nomogram using the rms package in R. Model discrimination and calibration were internally validated using Harrell's bootstrap optimism-correction method with 1000 resamples. Results: Postoperative ambulation was regained in 24 patients (24.7%). Four variables met the prespecified threshold (p < 0.10) for inclusion in the nomogram: preoperative motor grade (OR 2.48; 95% CI 1.41-4.34; p = 0.002), symptom onset-to-operation interval (OR 0.81; 95% CI 0.62-1.04; p = 0.098), preoperative KPS (OR 1.04; 95% CI 1.00-1.07; p = 0.070), and age (OR 0.97; 95% CI 0.93-1.01; p = 0.087); in the multivariable model, only preoperative motor grade and symptom onset-to-operation interval were independently associated with ambulatory recovery (p < 0.05). The nomogram achieved an apparent AUC of 0.827 (optimism-corrected, 0.800) and acceptable-to-good calibration (optimism-corrected calibration slope, 0.848; intercept, -0.088). At the Youden-optimal threshold, apparent (optimism-corrected) sensitivity, specificity, and F1 score were 79.2% (74.5%), 78.1% (76.7%), and 64.4% (60.6%), respectively. Conclusions: The nomogram demonstrated acceptable discrimination and good calibration for predicting postoperative ambulation in patients with MESCC. This tool may support individualized surgical decision-making and patient counseling. External validation is required before routine clinical use.
SN - 2077-0383
ER -