title: Prospective Cohort Study of Performance Status and Activities of Daily Living After Surgery for Spinal Metastasis.
abstract: METHODS
  A prospective cohort study of performance status (PS) and activities of daily living (ADL) in patients with spinal metastasis.
  
  
  OBJECTIVE
  To identify the effect of spinal surgery on PS and ADL in patients with spinal metastasis.
  
  
  BACKGROUND
  Spinal metastasis causes severe neurological deficits, resulting in drastic loss of patients' PS and ADL. However, the effect of spine surgery on PS and ADL is not well known.
  
  
  METHODS
  Seventy patients with spinal metastasis were enrolled in this study. Forty-six patients desired and underwent spine surgery ("surgery" group) and 24 patients did not desire surgery ("nonsurgery" group). Both groups received optimal treatments, including radiation, chemotherapy, and palliative care services. Evaluation was performed at 1, 3, and 6 months after study enrollment using the Eastern Cooperative Oncology Group PS, the Barthel index (BI) for ADL, and Frankel classification for neurological status.
  
  
  RESULTS
  There was no significant difference in baseline PS, the BI, or Frankel classification between the groups. The surgery group showed significant improvement in PS, maintaining grade 2 or less throughout the duration of the study, as well as in ADL, exceeding 70 points of the BI, compared with the nonsurgery group (P<0.05). Significantly improved neurological condition was also observed in the surgery group over the following 6 months. More than 95% of patients who underwent surgery improved their PS, the BI, and neurological status. Furthermore, >80% of these patients maintained improvement in PS, the BI, and neurological status for at least 6 months. In contrast, PS, the BI, and neurological status of patients in the "nonsurgery" group deteriorated throughout the study period.
  
  
  CONCLUSIONS
  Spine surgery improves PS, ADL, and neurological status in patients with spinal metastasis for a minimum 6 months. This indicates that these patients can acquire an independent daily life.
authors.affiliation: *Department of Orthopaedic Surgery †Division of Rehabilitation Medicine ‡Department of Radiation Oncology §Department of Palliative Medicine ∥Department of Medical Oncology/Hematology ¶Department of Rehabilitation Science, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kakutani
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Sakai
authors.forename: Koichiro
authors.initials: K
authors.lastname: Maeno
authors.forename: Toru
authors.initials: T
authors.lastname: Takada
authors.forename: Takashi
authors.initials: T
authors.lastname: Yurube
authors.forename: Takuto
authors.initials: T
authors.lastname: Kurakawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Terashima
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.forename: Hitomi
authors.initials: H
authors.lastname: Hara
authors.forename: Teruya
authors.initials: T
authors.lastname: Kawamoto
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ejima
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sakashita
authors.forename: Naomi
authors.initials: N
authors.lastname: Kiyota
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.forename: Ryohei
authors.initials: R
authors.lastname: Sasaki
authors.forename: Toshihro
authors.initials: T
authors.lastname: Akisue
authors.forename: Hironobu
authors.initials: H
authors.lastname: Minami
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kuroda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nishida
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003710:Demography; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome