Quality of life and functional outcomes after surgery for spinal metastases: Results of a cohort study

Article type: Research Article

Authors: Westermann, Leonard^{a; *} | Eysel, Peer^a | Luge, Hannah^a | Olivier, Alain^a | Oikonomidis, Stavros^a | Baschera, Dominik^b | Zarghooni, Kourosh^a

Affiliations: [a] Centre of Orthopedic and Trauma Surgery, University Medical Centre, 50937 Cologne, Germany | [b] Department of Neurosurgery, Kantonsspital Winterthur, 8401 Winterthur, Switzerland

Correspondence: [*] Corresponding author: Leonard Westermann, Centre of Orthopedic and Trauma Surgery, University Medical Centre, Kerpener Str. 62, 50937 Cologne, Germany. Tel.: +49 221 478 7945; Fax: +49 221 478 6060; E-mail: leonard.westermann@uk-koeln.de.

Abstract: BACKGROUND: Spinal metastases are being diagnosed more frequently because of increasing life expectancies and advances in the diagnosis and therapy of primary tumours. OBJECTIVE: This aim of this study was to assess the quality of life (QoL) and functional outcomes after surgical intervention for spinal metastases in a large cohort. METHODS: A single-centre, prospective, observational study was conducted from June 2016 to February 2018. Patients treated surgically for spinal metastasis were included. Primary endpoints were the Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI), and QoL questionnaire (EuroQoL-5D) scores recorded preoperatively, 6 weeks postoperatively, and 3, 6, and 12 months postoperatively. RESULTS: Ninety-two patients (mean age, 62.7 ± 12.8 years) were included. The most frequent neoplasms were multiple myeloma (n= 18; 19.6%), lung cancer (n= 16; 17.4%), prostate cancer (n= 14; 15.2%), and breast cancer (n= 11; 12.0%). During the observation period, 44.6% of patients died. The COMI score improved significantly from preoperatively (mean, 7.1; 95% CI, 6.6–7.6) to 3 months (mean, 5.5; 95% CI, 4.8–6.2; p= 0.01) and 12 months (mean, 4.6; 95% CI, 3.7–5.5; p= 0.001) postoperatively. The ODI showed a significant improvement from preoperatively (mean, 52.9; 95% CI, 48.5–57.4) to 6 weeks (mean, 43.4; 95% CI, 37.1–49.6; p= 0.03), 3 months (mean, 37.0; 95% CI, 31.0–42.9) 6 months mean, 40.5; 95% CI, 34.2–46.8; p= 0.01), and 12 months (mean, 31.9; 95% CI, 24.8–39.1; p= 0.005) postoperatively. Improvements in the COMI at 6 weeks (p= 0.05), and 6 months (p= 0.05) postoperatively were not statistically significant. QoL improved from preoperatively to 6 weeks (mean, 0.48; 95% CI, 0.38–0.59; p= 0.002), 3 months (mean, 0.50; 95% CI, 0.38–0.61; p= 0.009), and 12 months (mean, 0.61; 95% CI, 0.51–0.71; p= 0.001) postoperatively. After 6 months, the difference was not significant (p= 0.08). CONCLUSION: Short-term and long-term improvements in functional outcomes and QoL were observed after surgical treatment of spinal metastases. Surgery is a good option for patients with an estimated life expectancy of more than 3 months.

Keywords: Spinal metastases, spine, metastatic spine surgery, quality of life, functional outcome, Core Outcome Measures Index

DOI: 10.3233/THC-191727

Journal: Technology and Health Care, vol. 28, no. 3, pp. 303-314, 2020