Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort

Abstract

Introduction Metastatic spinal cancer is a common condition that may lead to spinal instability, pain and paralysis. In the 1980s, surgery was discouraged because results showed worse neurological outcomes and pain compared with radiotherapy alone. However, with the advent of modern imaging and spinal stabilisation techniques, the role of surgery has regained centre stage, though few studies have assessed quality of life and functional outcomes after surgery. Objective We investigated whether surgery provides sustained improvement in quality of life and pain relief for patients with symptomatic spinal metastases by analysing the largest reported surgical series of patients with epidural spinal metastases. Methods A prospective cohort study of 922 consecutive patients with spinal metastases who underwent surgery, from the Global Spine Tumour Study Group database. Pre- and post-operative EQ-5D quality of life, visual analogue pain score, Karnofsky physical functioning score, complication rates and survival were recorded. Results Quality of life (EQ-5D), VAS pain score and Karnofsky physical functioning score improved rapidly after surgery and these improvements were sustained in those patients who survived up to 2 years after surgery. In specialised spine centres, the technical intra-operative complication rate of surgery was low, however almost a quarter of patients experienced post-operative systemic adverse events. Conclusion Surgical treatment for spinal metastases produces rapid pain relief, maintains ambulation and improves good quality of life. However, as a group, patients with cancer are vulnerable to post-operative systemic complications, hence the importance of appropriate patient selection.

KEYWORDS:

• Metastasis
• quality of life
• spine
• surgery
• outcome

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

This work was funded by the Global Spine Tumour Study Group, a registered charity of England and Wales, Charity Commission number 1134934, and DePuy Synthes (Johnson and Johnson). This study was performed in part at University College London Biomedical Research Centre, which receives funding from the National Institute for Health Research, UK.

D.C. received research funding from European Research Council.

T.A.: RoyaltiesDePuy Synthes,Consultant DePuy Synthes, Royalties Biomet Spine, Stockholder Paradigm Spine.

M.A. received Research funding and consults for Inspine, Biomet, Silony, Amedica.

J.B. is a Consultant for Advance medica, and received funding from Corelink inc, Globus Medical, K2M, Medtronic, Stryker. J.B. is in teaching arrangements with Broadwater/Vertical health, DePuy Synthes, Orthofix. J.B. has received royalties from Wolters Kluwer Health (textbook), Globus Medical (for spine instrumentation); research grant/institutional support from CSSG/K2M inc.

J.H. is a Consultant for DePuy Spine, and is on the Bioventus advisory board.

E.M. is a member of AO Spine North America, receiving honoraria.