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


Authors: Barzilai, O.; Versteeg, A. L.; Goodwin, C. R.; Sahgal, A.; Rhines, L. D.; Sciubba, D. M.; Schuster, J. M.; Weber, M. H.; Lazary, A.; Fehlings, M. G.; Clarke, M. J.; Arnold, P. M.; Boriani, S.; Bettegowda, C.; Gokaslan, Z. L.; Fisher, C. G.; Laufer, I.; for the AOSpine Knowledge Forum Tumor
Article Title: 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. © 2019 American Cancer Society
Keywords: adult; survival rate; major clinical study; overall survival; clinical trial; postoperative care; treatment; outcome assessment; follow up; prospective study; disease association; quality of life; questionnaire; multicenter study; spinal cord compression; spine; surgical risk; urinary tract infection; surgery; postoperative infection; clinical effectiveness; tumor; short form 36; neurologic disease; functional status; spinal cord metastasis; deterioration; spinal cord surgery; nervous system function; spinal instability neoplastic score; health-related quality of life (hrqol); human; male; female; priority journal; article; metastatic epidural spinal cord compression; neurologic deficit; american spinal injury association impairment scale; motor dysfunction assessment; spine oncology study group outcomes questionnaire
Journal Title: Cancer
Volume: 125
Issue: 23
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2019-12-01
Start Page: 4224
End Page: 4231
Language: English
DOI: 10.1002/cncr.32420
PUBMED: 31410854
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 2 December 2019 -- Source: Scopus
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MSK Authors
  1. Ilya Laufer
    109 Laufer