title: Optimizing the Adverse Event and HRQOL Profiles in the Management of Primary Spine Tumors.
abstract: METHODS
  Systematic literature review.
  
  
  OBJECTIVE
  To investigate if evidence-based principles of oncologic resection for primary spinal tumors are correlated with an acceptable morbidity and mortality profile and satisfactory health-related quality of life (HRQOL) measures.
  
  
  BACKGROUND
  Respecting oncologic principles for primary spinal tumor surgery is correlated with lower recurrence rates. These interventions are, however, often highly morbid.
  
  
  METHODS
  A systematic literature review was performed to address the objectives by searching MEDLINE and EBMR databases. Articles that met our inclusion criteria were reviewed. GRADE guidelines were used for recommendation formulation.
  
  
  RESULTS
  A total of 25 articles addressing the morbidity and mortality profile of primary spinal tumor surgery were identified. For sacral tumors, complication rates of up to 100% have been reported and complication-related death ranged from 0% to 27%. Mobile spine tumor complication rates varied from 13% to 73.7% and complication-related death ranged from 0% to 7.7%. Seven articles examining HRQOL for this patient population were identified. The limited literature showed comparable patient HRQOL profiles to those with benign conditions such as degenerative disc disease.
  
  
  CONCLUSIONS
  Respecting oncologic principles for primary spinal tumors are correlated with high adverse event rates. We recommend that primary spinal tumor surgeries be performed in experienced centers with multidisciplinary support teams and that prospective adverse event collection be promoted (strong recommendation/very low certainty of the evidence). Oncologic resection of primary tumors of the spine is associated with HRQOL that more closely approximates normative values with increasing duration of follow-up, but decreases with disease recurrence. We recommend primary spinal tumor surgery be performed with a curative intent whenever possible, even at the expense of greater initial morbidity to optimize long-term HRQOL (strong recommendation/very low certainty of the evidence).
  
  
  METHODS
  N/A.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dea
authors.affiliation: Department of Orthopaedics, Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada.
authors.forename: Raphaële
authors.initials: R
authors.lastname: Charest-Morin
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Orthopedic Oncology, Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bird
authors.affiliation: Center for Orthopaedics and Traumatology (OUC), University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Disch
authors.affiliation: Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
authors.affiliation: National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.
authors.forename: Áron
authors.initials: Á
authors.lastname: Lazáry
authors.affiliation: Department of Orthopaedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.affiliation: Department of Neurosurgery, University of California-San Francisco Medical Center, San Francisco, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
mesh_terms: D006304:Health Status; D006801:Humans; D011788:Quality of Life; D013125:Spinal Neoplasms / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome