Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients

Abstract

Purpose: There are few prospective studies on surgical outcomes and survival in patients with metastatic disease to the spine. The magnitude and duration of effect of surgery on pain relief and quality of life remains uncertain. Therefore, the aim of this clinical study was to prospectively evaluate clinical, functional, quality of life and survival outcomes after palliative surgery for vertebral metastases.

Methods: 118 consecutive patients who underwent spinal surgery for symptomatic vertebral metastases were prospectively followed up for 12 months or until death. Clinical data and data from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire were obtained pre- and post-operatively and at regular follow-up intervals.

Results: Surgery was effective in achieving rapid improvement in axial and radicular pain, neurological deficit, sphincteric dysfunction and ambulatory status, with a complication rate of 26% and a 12 month mortality rate of 48%. Almost 50% of patients had complete resolution of back pain, radiculopathy and neurological deficit. Of the patients who were non-ambulant and incontinent, over 50% regained ambulatory ability and recovered urinary continence. The overall incidence of wound infection or breakdown was 6.8% and the local recurrence rate was 8.5%. There was a highly significant improvement in physical, role, cognitive and emotional functioning and global health status post-operatively. Greatest improvement in pain, function and overall quality of life occurred in the early post-operative period and was maintained until death or during the 12 month prospective follow-up period.

Conclusion: The potential for immediate and prolonged improvement in pain, function and quality of life in patients with symptomatic vertebral metastases should be considered during the decision-making process when selecting and counselling patients for surgery.

Fig. 1

Kaplan-Meier survival curve showing overall survival of all patients following surgery, with 95% confidence intervals

Fig. 2

Average EORTC QLQ-C30 scores of all patients for global health status and cognitive, emotional, physical, social and role functioning are illustrated at pre-operative, 1-, 3-, 6- and 12-month post-operative time points

Fig. 3

Average EORTC QLQ-C30 scores of the 47 patients who were known 12-month survivors at the end of the prospective study period for global health status and cognitive, emotional, physical, social and role functioning are illustrated at pre-operative, 1-, 3-, 6- and 12-month post-operative time points. Baseline pre-operative scores were all slightly higher than the average scores for all patients but the magnitude and maintenance of improvement was similar to that seen in Fig. 2

Fig. 4

Average EORTC QLQ-C30 score for pain for all patients are illustrated at pre-operative, 1-, 3-, 6- and 12-month post-operative time points

Fig. 5

Average EORTC QLQ-C30 score for pain for the 47 patients who were known 12-month survivors at the end of the prospective study period are illustrated at pre-operative, 1-, 3-, 6- and 12-month post-operative time points. The magnitude and maintenance of improvement was similar to the average scores for all patients as illustrated in Fig. 4