title: Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale.
abstract: OBJECT The aim of this study was to evaluate outcome in patients undergoing surgical treatment for intradural spinal tumor using a patient-oriented, self-rated, outcome instrument and a physician-based disease-specific instrument. METHODS Prospectively collected data from 63 patients with intradural spinal tumor were analyzed in relation to scores on the multidimensional patient-rated Core Outcome Measures Index (COMI) and the physician-rated modified McCormick Scale, before and at 3 and 12 months after surgery. RESULTS There was no statistically significant difference between the scores on the modified McCormick Scale preoperatively and at the 3-month follow-up, though there was a trend for improvement (p = 0.073); however, comparisons between the scores determined preoperatively and at the 12-month follow-up, as well as 3- versus 12-month follow-ups, showed a statistically significant improvement in each case (p < 0.004). The COMI scores for axial pain, peripheral pain, and back-related function showed a significant reduction (p < 0.001) from before surgery to 3 months after surgery, and thereafter showed no further change (p > 0.05) up to 12 months postoperatively. In contrast, the overall COMI score, "worst pain," quality of life, and social disability not only showed a significant reduction from before surgery to 3 months after surgery (p < 0.001), but also a further significant reduction up to 12 months postoperatively (p < 0.001). The scores for work disability showed no significant improvement from before surgery to the 3-month follow-up (p > 0.05), but did show a significant improvement (p = 0.011) from 3 months to 12 months after surgery. At the 3- and 12-month follow-ups, 85.2% and 83.9% of patients, respectively, declared that the surgical procedure had helped/helped a lot; 95.1% and 95.2%, respectively, declared that they were satisfied/very satisfied with their care. CONCLUSIONS COMI is a feasible tool to use in the evaluation of baseline symptoms and outcome in patients undergoing surgery for intradural spinal tumor. COMI was able to detect changes in outcome at 3 months after surgery (before changes were apparent on the modified McCormick Scale) and on later postoperative follow-up. The COMI subdomains are valuable for monitoring the patient's reintegration into society and the work environment. The addition of an item that specifically covers neurological deficits may further increase the value of COMI in patients with spinal tumors.
authors.affiliation: Spine Center and.|Department of Neurosurgery, University Hospital Zürich, University of Zürich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Bellut
authors.affiliation: Spine Center and.|Department of Neurosurgery, University Hospital Zürich, University of Zürich, Switzerland.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Research and Development, Spine Center Division, Schulthess Clinic Zürich; and.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Mannion
authors.affiliation: Spine Center and.
authors.forename: François
authors.initials: F
authors.lastname: Porchet
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D013120:Spinal Cord Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome
keywords: COMI; COMI = Core Outcome Measures Index; Core Outcome Measures Index; McCormick Scale; intradural; outcome; spine; surgery