Association of neurologic deficits with surgical outcomes and health‐related quality of life after treatment for metastatic epidural spinal cord compression

Abstract

Background A critical knowledge gap exists regarding the impact of neurologic deficits on surgical outcomes and health‐related quality of life (HRQOL) for patients surgically treated for metastatic epidural spinal cord compression (MESCC). Methods This prospective, multicenter and international study analyzed the impact of the neurologic status on functional status, HRQOL, and postoperative survival. The collected data included the patient demographics, overall survival, American Spinal Injury Association (ASIA) impairment scale, Spinal Instability Neoplastic Score, treatment details and complications and HRQOL measures, including version 2 of the 36‐Item Short Form Health Survey (SF‐36v2) and version 2.0 of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). Results A total of 239 patients surgically treated for spinal metastases were included. Six weeks after treatment, 99 of the 108 patients with a preoperative ASIA grade of E remained stable, 8 deteriorated to ASIA D, and 1 deteriorated to ASIA A. Of 55 patients with ASIA D, 27 improved to ASIA E, 27 remained stable and 1 deteriorated to ASIA C. Of 11 patients with ASIA A to C, 2 improved to ASIA E, 4 improved to ASIA D, and 5 remained stable. At the 6‐ and 12‐week follow‐up, better ASIA scores were associated with better scores on multiple SF‐36v2 and SOSGOQ items. Postoperatively, patients with ASIA grades of A to D were more likely to have urinary tract infections and wound complications. Patients with a baseline ASIA grade of E or D survived significantly longer. Conclusions Patients with neurologic deficits due to MESCC have worse HRQOL and decreased overall survival. Nevertheless, surgery can result in stabilization or improvement of neurologic function which may translate into better HRQOL. Postoperative care and follow‐up are challenging for patients with neurologic deficits because they experience more complications.

Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

“…Other studies have also highlighted the prognostic role of poor performance status and neurological deficit in spinal metastatic disease. 25 Patients with good functional status have significant positive changes in neurological function after surgery and are able to avoid infectious, vascular, and respi-FIG. 3.…”

Neurological outcomes after surgery for spinal metastases in symptomatic patients: Does the type of decompression play a role? A comparison between different strategies in a 10-year experience

“…Given this, the treatment of patients with SSCC poses a unique challenge. The restoration of a proper clinical status in a metastatic patient is mandatory to maintain a proper quality of life while avoiding to reduce the overall survival [4] . The treatment of symptomatic spinal cord compression still remains mainly a surgical issue, at first, since surgery is able to rescue quickly the spinal cord when necessary [26] , [27] , [28] , [29] .…”

“…(HRQoL) [1] , [2] , [3] . Recently, a prospective, multi-centric, international study has analyzed how neurological deficits could impair functional status, HRQoL, and overall survival [4] . Results showed that patients with neurological deficits have reduced overall survival and worse HRQoL and that the need for an early diagnosis is of paramount importance.…”

Quality of Life and Mental Health Status Among Cancer Patients With Metastatic Spinal Disease

“…As an advanced stage of cancer, metastatic spinal disease is often characterized by severe back pain, infection, neurological sequelae, and ambulatory disability (8), which are particularly challenging for surgeons. Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications. Studies have demonstrated that surgical interventions could be capable of improving the quality of patient's remaining life due to immediate pain relief and functional recovery among patients with spine metastasis (10)(11)(12).…”

“…Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications. Studies have demonstrated that surgical interventions could be capable of improving the quality of patient's remaining life due to immediate pain relief and functional recovery among patients with spine metastasis (10)(11)(12).…”