Ori Barzilai1, Anne L Versteeg2, C Rory Goodwin3, Arjun Sahgal4, Laurence D Rhines5, Daniel M Sciubba6, James M Schuster7, Michael H Weber8, Aron Lazary9, Michael G Fehlings10, Michelle J Clarke11, Paul M Arnold12, Stefano Boriani13, Chetan Bettegowda6, Ziya L Gokaslan14, Charles G Fisher15, Ilya Laufer1. 1. Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York. 2. Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina. 4. Department of Radiation Oncology, Sunnybrook Odette Cancer Center and University of Toronto, Toronto, Ontario, Canada. 5. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 7. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 8. Division of Surgery, McGill University and Montreal General Hospital, Montreal, Quebec, Canada. 9. National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary. 10. Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada. 11. Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota. 12. Department of Neurosurgery, University of Kansas Hospital, Kansas City, Kansas. 13. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS (Institute of Hospitalization and Scientific Care)) Galeazzi Orthopedic Institute, Milan, Italy. 14. Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, and Miriam Hospital, Providence, Rhode Island. 15. Division of Spine, Department of Orthopedics, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: A critical knowledge gap exists regarding the impact of neurologic deficits on surgical outcomes and health-related quality of life (HRQOL) for patients surgically treated for metastatic epidural spinal cord compression (MESCC). METHODS: This prospective, multicenter and international study analyzed the impact of the neurologic status on functional status, HRQOL, and postoperative survival. The collected data included the patient demographics, overall survival, American Spinal Injury Association (ASIA) impairment scale, Spinal Instability Neoplastic Score, treatment details and complications and HRQOL measures, including version 2 of the 36-Item Short Form Health Survey (SF-36v2) and version 2.0 of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). RESULTS: A total of 239 patients surgically treated for spinal metastases were included. Six weeks after treatment, 99 of the 108 patients with a preoperative ASIA grade of E remained stable, 8 deteriorated to ASIA D, and 1 deteriorated to ASIA A. Of 55 patients with ASIA D, 27 improved to ASIA E, 27 remained stable and 1 deteriorated to ASIA C. Of 11 patients with ASIA A to C, 2 improved to ASIA E, 4 improved to ASIA D, and 5 remained stable. At the 6- and 12-week follow-up, better ASIA scores were associated with better scores on multiple SF-36v2 and SOSGOQ items. Postoperatively, patients with ASIA grades of A to D were more likely to have urinary tract infections and wound complications. Patients with a baseline ASIA grade of E or D survived significantly longer. CONCLUSIONS: Patients with neurologic deficits due to MESCC have worse HRQOL and decreased overall survival. Nevertheless, surgery can result in stabilization or improvement of neurologic function which may translate into better HRQOL. Postoperative care and follow-up are challenging for patients with neurologic deficits because they experience more complications.
BACKGROUND: A critical knowledge gap exists regarding the impact of neurologic deficits on surgical outcomes and health-related quality of life (HRQOL) for patients surgically treated for metastatic epidural spinal cord compression (MESCC). METHODS: This prospective, multicenter and international study analyzed the impact of the neurologic status on functional status, HRQOL, and postoperative survival. The collected data included the patient demographics, overall survival, American Spinal Injury Association (ASIA) impairment scale, Spinal Instability Neoplastic Score, treatment details and complications and HRQOL measures, including version 2 of the 36-Item Short Form Health Survey (SF-36v2) and version 2.0 of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). RESULTS: A total of 239 patients surgically treated for spinal metastases were included. Six weeks after treatment, 99 of the 108 patients with a preoperative ASIA grade of E remained stable, 8 deteriorated to ASIA D, and 1 deteriorated to ASIA A. Of 55 patients with ASIA D, 27 improved to ASIA E, 27 remained stable and 1 deteriorated to ASIA C. Of 11 patients with ASIA A to C, 2 improved to ASIA E, 4 improved to ASIA D, and 5 remained stable. At the 6- and 12-week follow-up, better ASIA scores were associated with better scores on multiple SF-36v2 and SOSGOQ items. Postoperatively, patients with ASIA grades of A to D were more likely to have urinary tract infections and wound complications. Patients with a baseline ASIA grade of E or D survived significantly longer. CONCLUSIONS:Patients with neurologic deficits due to MESCC have worse HRQOL and decreased overall survival. Nevertheless, surgery can result in stabilization or improvement of neurologic function which may translate into better HRQOL. Postoperative care and follow-up are challenging for patients with neurologic deficits because they experience more complications.
Authors: Naresh Kumar; Andrew Thomas; Sirisha Madhu; Miguel Rafael David Ramos; Liang Shen; Joel Yong Hao Tan; Andre Villanueva; Nivetha Ravikumar; Gabriel Liu; Hee Kit Wong Journal: Eur Spine J Date: 2021-01-18 Impact factor: 3.134
Authors: F Cofano; G Di Perna; A Alberti; B M Baldassarre; M Ajello; N Marengo; F Tartara; F Zenga; D Garbossa Journal: J Bone Oncol Date: 2020-11-10 Impact factor: 4.072