Michael G Fehlings1, Anick Nater2, Lindsay Tetreault2, Branko Kopjar2, Paul Arnold2, Mark Dekutoski2, Joel Finkelstein2, Charles Fisher2, John France2, Ziya Gokaslan2, Eric Massicotte2, Laurence Rhines2, Peter Rose2, Arjun Sahgal2, James Schuster2, Alexander Vaccaro2. 1. Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA. michael.fehlings@uhn.on.ca. 2. Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA.
Abstract
PURPOSE: Although surgery is used increasingly as a strategy to complement treatment with radiation and chemotherapy in patients with metastatic epidural spinal cord compression (MESCC), the impact of surgery on health-related quality of life (HRQoL) is not well established. We aimed to prospectively evaluate survival, neurologic, functional, and HRQoL outcomes in patients with MESCC who underwent surgical management. PATIENTS AND METHODS: One hundred forty-two patients with a single symptomatic MESCC lesion who were treated surgically were enrolled onto a prospective North American multicenter study and were observed at least up to 12 months. Clinical data, including Brief Pain Inventory, ASIA (American Spinal Injury Association) impairment scale, SF-36 Short Form Health Survey, Oswestry Disability Index, and EuroQol 5 dimensions (EQ-5D) scores, were obtained preoperatively, and at 6 weeks and 3, 6, 9, and 12 months postoperatively. RESULTS: Median survival time was 7.7 months. The 30-day and 12-month mortality rates were 9% and 62%, respectively. There was improvement at 6 months postoperatively for ambulatory status (McNemar test, P < .001), lower extremity and total motor scores (Wilcoxon signed rank test, P < .001), and at 6 weeks and 3, 6, and 12 months for Oswestry Disability Index, EQ-5D, and pain interference (paired t test, P < .013). Moreover, at 3 months after surgery, the ASIA impairment scale grade was improved (Stuart-Maxwell test P = .004). SF-36 scores improved postoperatively in six of eight scales. The incidence of wound complications was 10% and 2 patients required a second surgery (screw malposition and epidural hematoma). CONCLUSION: Surgical intervention, as an adjunct to radiation and chemotherapy, provides immediate and sustained improvement in pain, neurologic, functional, and HRQoL outcomes, with acceptable risks in patients with a focal symptomatic MESCC lesion who have at least a 3 month survival prognosis.
PURPOSE: Although surgery is used increasingly as a strategy to complement treatment with radiation and chemotherapy in patients with metastatic epidural spinal cord compression (MESCC), the impact of surgery on health-related quality of life (HRQoL) is not well established. We aimed to prospectively evaluate survival, neurologic, functional, and HRQoL outcomes in patients with MESCC who underwent surgical management. PATIENTS AND METHODS: One hundred forty-two patients with a single symptomatic MESCC lesion who were treated surgically were enrolled onto a prospective North American multicenter study and were observed at least up to 12 months. Clinical data, including Brief Pain Inventory, ASIA (American Spinal Injury Association) impairment scale, SF-36 Short Form Health Survey, Oswestry Disability Index, and EuroQol 5 dimensions (EQ-5D) scores, were obtained preoperatively, and at 6 weeks and 3, 6, 9, and 12 months postoperatively. RESULTS: Median survival time was 7.7 months. The 30-day and 12-month mortality rates were 9% and 62%, respectively. There was improvement at 6 months postoperatively for ambulatory status (McNemar test, P < .001), lower extremity and total motor scores (Wilcoxon signed rank test, P < .001), and at 6 weeks and 3, 6, and 12 months for Oswestry Disability Index, EQ-5D, and pain interference (paired t test, P < .013). Moreover, at 3 months after surgery, the ASIA impairment scale grade was improved (Stuart-Maxwell test P = .004). SF-36 scores improved postoperatively in six of eight scales. The incidence of wound complications was 10% and 2 patients required a second surgery (screw malposition and epidural hematoma). CONCLUSION: Surgical intervention, as an adjunct to radiation and chemotherapy, provides immediate and sustained improvement in pain, neurologic, functional, and HRQoL outcomes, with acceptable risks in patients with a focal symptomatic MESCC lesion who have at least a 3 month survival prognosis.
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