The Short-Term Effect of Surgery on Health Related Quality of Life and Functional Outcome in Patients with Metastatic Epidural Spinal Cord Compression (MESCC)– Results of the ongoing AOSpine North America Prospective Multicenter Study

Branko Kopjar1, Michael Fehlings, MD1, Charles Fisher, MD1, Laurence Rhines, MD1, Paul Arnold, MD1, James Schuster, MD1, Alexander Vaccaro, MD1, Ziya Gokaslan, MD1, Joel Finkelstein, MD1, John France, MD1, Mark Dekutoski, MD1

1Seattle, WA United States

Keywords: quality of life, registry, spine surgery, spine tumors, outcome

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     Studies have provided evidence that in selected patients combined surgery and radiotherapy provides the optimal neurological recovery in MESCC patients. However, patients with MESCC have relatively short life-expectancy and face numerous health challenges.
     The impact of surgery on improving quality of life outcomes in the setting of MESCC is unknown.
     111 surgical patients were enrolled in a prospective multi-center, cohort study involving 10 sites in North America.
     Outcomes were assessed using the pain assessments, ASIAscale, SF-36v2, and EQ-5D.
     Average age was 58 years, 59 percent were males. Common primary sites were lungs (24 percent), prostate (12 percent), breast (13 percent), and kidney (12 percent). 67 percent survived three months, only 33 percent survived 12 months. The survival was associated with site of primary cancer. In survivors, the average improvement at 3 month was for .23 for EQ5D (P < .01), 19.2 for ODI (P < .01), 2.1 for VAS Pain (P < .01). Also, there was a significant improvement in ASIA Impairment grade (P < .01). The changes in SF36 PCS and MCS were not significant.
     This is a prospective non-randomized study.
     Surgically treated patients with MESCC are a diverse group of patients with different prognoses.
     The surviving patients experience clinically relevant symptoms improvement and gains in function and utility. Individuals with less than three month life expectancy may be less than ideal candidates for surgical intervention.


Project Roles:

B. Kopjar (), M. Fehlings (), C. Fisher (), L. Rhines (), P. Arnold (), J. Schuster (), A. Vaccaro (), Z. Gokaslan (), J. Finkelstein (), J. France (), M. Dekutoski ()