title: Quality of Life Outcomes Following Resection of Adult Intramedullary Spinal Cord Tumors.
abstract: Intramedullary spinal cord tumors are rare but clinically significant entities. Resection is critical to prevent permanent neurological deficits. However, no studies have investigated the quality of life (QOL) benefit of resection in adults.
  
  
  
  To investigate QOL outcomes after intramedullary spinal cord tumors resection.
  
  
  
  A consecutive retrospective review of all patients who underwent intramedullary spinal cord tumors resection at a single tertiary care institution between January 2008 and December 2013 was conducted. QOL was measured by the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to identify independent predictors of outcomes.
  
  
  
  Among 45 patients, the most common pathology was ependymoma (60%). No significant changes between preoperative and postoperative EQ-5D, PDQ, or PHQ-9 were observed. Improvements exceeding the minimal clinically important difference occurred in 28% of patients in EQ-5D, 28% in PDQ, and 16% in PHQ-9. Worse preoperative neurological status predicted worsened EQ-5D (β = -0.09, P = .04) and PDQ (β = 20.77, P < .01), while ependymomas predicted QOL improvement exceeding the minimal clinically important difference in PDQ (OR 14.98, P = .04) and approached significance in EQ-5D (OR 43.52, P = .06). Conversely, cervical tumors predicted worsened PDQ (β = 18.32, P < .01) and failure to achieve EQ-5D minimal clinically important difference (OR <0.01, 95% CI <0.01-0.65, P = .02). Postoperative complications, such as syrinx formation (β = -0.09, P = .04) and cerebrospinal fluid leak (β = 13.85, P = .04), predicted diminished improvement in EQ-5D and PDQ, respectively.
  
  
  
  Although resection did not significantly improve QOL, it is likely necessary to arrest QOL deterioration. Patients with better preoperative neurological status or ependymoma experienced QOL improvement, while postoperative complications negatively impacted long-term QOL.
  
  
  
  EQ-5D, EuroQol 5-DimensionsGTR, gross total resectionIMSCT, intramedullary spinal cord tumorsMCID, minimal clinically important differenceMMS, Modified McCormick ScalePDQ, Pain Disability QuestionnairePHQ-9, Patient Health Questionnaire-9POD, plane of dissectionQOL, quality of lifeSSI, surgical site infection.
authors.affiliation: *Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio; ‡Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; §Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; ¶Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; ‖Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Roy
authors.initials: R
authors.lastname: Xiao
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Miller
authors.forename: Kalil G
authors.initials: KG
authors.lastname: Abdullah
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome