title: Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort.
abstract: Introduction Metastatic spinal cancer is a common condition that may lead to spinal instability, pain and paralysis. In the 1980s, surgery was discouraged because results showed worse neurological outcomes and pain compared with radiotherapy alone. However, with the advent of modern imaging and spinal stabilisation techniques, the role of surgery has regained centre stage, though few studies have assessed quality of life and functional outcomes after surgery. Objective We investigated whether surgery provides sustained improvement in quality of life and pain relief for patients with symptomatic spinal metastases by analysing the largest reported surgical series of patients with epidural spinal metastases. Methods A prospective cohort study of 922 consecutive patients with spinal metastases who underwent surgery, from the Global Spine Tumour Study Group database. Pre- and post-operative EQ-5D quality of life, visual analogue pain score, Karnofsky physical functioning score, complication rates and survival were recorded. Results Quality of life (EQ-5D), VAS pain score and Karnofsky physical functioning score improved rapidly after surgery and these improvements were sustained in those patients who survived up to 2 years after surgery. In specialised spine centres, the technical intra-operative complication rate of surgery was low, however almost a quarter of patients experienced post-operative systemic adverse events. Conclusion Surgical treatment for spinal metastases produces rapid pain relief, maintains ambulation and improves good quality of life. However, as a group, patients with cancer are vulnerable to post-operative systemic complications, hence the importance of appropriate patient selection.
authors.affiliation: a Department of Neurosurgery , National Hospital for Neurology and Neurosurgery, University College London , London , UK ;
authors.forename: David
authors.initials: D
authors.lastname: Choi
authors.affiliation: a Department of Neurosurgery , National Hospital for Neurology and Neurosurgery, University College London , London , UK ;
authors.forename: Zoe
authors.initials: Z
authors.lastname: Fox
authors.affiliation: b Departments of Neurosurgery , Thomas Jefferson University and Hospitals , PA , USA ;|c Department of Orthopedic Surgery , Thomas Jefferson University and Hospitals , PA , USA ;
authors.forename: Todd
authors.initials: T
authors.lastname: Albert
authors.affiliation: d Department of Neurosurgery , Medical Center Haaglanden , Haaglanden , the Netherlands ;
authors.forename: Mark
authors.initials: M
authors.lastname: Arts
authors.affiliation: e Department of Orthopedic Surgery , L'institut Mutualiste Montsouris , Paris , France ;
authors.forename: Laurent
authors.initials: L
authors.lastname: Balabaud
authors.affiliation: f Department of Orthopedic Surgery , University Hospital of Aarhus , Aarhus , Denmark ;
authors.forename: Cody
authors.initials: C
authors.lastname: Bunger
authors.affiliation: g Departments of Orthopedic and Neurological Surgery , Washington University , MO , USA ;
authors.forename: Jacob Maciej
authors.initials: JM
authors.lastname: Buchowski
authors.affiliation: h Department of Neurosurgery , Groningen , the Netherlands ;
authors.forename: Maarten Hubert
authors.initials: MH
authors.lastname: Coppes
authors.affiliation: i Division of Neurosurgery , University Hospital Leuven , Leuven , Belgium ;
authors.forename: Bart
authors.initials: B
authors.lastname: Depreitere
authors.affiliation: j Department of Neurosurgery , Toronto Western Hospital , Toronto , Canada ;
authors.forename: Michael George
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: b Departments of Neurosurgery , Thomas Jefferson University and Hospitals , PA , USA ;|c Department of Orthopedic Surgery , Thomas Jefferson University and Hospitals , PA , USA ;
authors.forename: James
authors.initials: J
authors.lastname: Harrop
authors.affiliation: k Department of Orthopedic Surgery , Kanazawa Medical University Hospital , Kanazawa , Japan ;
authors.forename: Norio
authors.initials: N
authors.lastname: Kawahara
authors.affiliation: l Spinal Unit, Hospital Universitario Dr Peset , Valencia , Spain ;
authors.forename: Juan Anthonio
authors.initials: JA
authors.lastname: Martin-Benlloch
authors.affiliation: j Department of Neurosurgery , Toronto Western Hospital , Toronto , Canada ;
authors.forename: Eric Maurice
authors.initials: EM
authors.lastname: Massicotte
authors.affiliation: e Department of Orthopedic Surgery , L'institut Mutualiste Montsouris , Paris , France ;
authors.forename: Christian
authors.initials: C
authors.lastname: Mazel
authors.affiliation: m Department of Orthopedic Surgery , University Medical Center Utrecht , Utrecht , the Netherlands ;
authors.forename: Fetullah Cumhur
authors.initials: FC
authors.lastname: Oner
authors.affiliation: c Department of Orthopedic Surgery , Thomas Jefferson University and Hospitals , PA , USA ;|n Department of Neurosurgery , Leiden University Medical Centre , Leiden , the Netherlands ;
authors.forename: Wilco
authors.initials: W
authors.lastname: Peul
authors.affiliation: o Centre for Spine Studies and Surgery, Queens Medical Centre , Nottingham , UK ;
authors.forename: Nasir
authors.initials: N
authors.lastname: Quraishi
authors.affiliation: p Department of Orthopedic Surgery , Nihon University School of Medicine , Japan ;
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tokuhashi
authors.affiliation: q Department of Orthopedic Surgery , Kanazawa University , Kanazawa , Japan ;
authors.forename: Katsuro
authors.initials: K
authors.lastname: Tomita
authors.affiliation: m Department of Orthopedic Surgery , University Medical Center Utrecht , Utrecht , the Netherlands ;
authors.forename: Jorit Jan
authors.initials: JJ
authors.lastname: Verlaan
authors.affiliation: f Department of Orthopedic Surgery , University Hospital of Aarhus , Aarhus , Denmark ;
authors.forename: Miao
authors.initials: M
authors.lastname: Wang
authors.affiliation: r Department of Neurosurgery , Jackson Memorial Hospital, University of Miami , FL , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Wang
authors.affiliation: a Department of Neurosurgery , National Hospital for Neurology and Neurosurgery, University College London , London , UK ;
authors.forename: Hugh Alan
authors.initials: HA
authors.lastname: Crockard
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000601:surgery*; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome
keywords: Metastasis; outcome; quality of life; spine; surgery