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

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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.

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Acknowledgments

This study was part of an approved French National Research and Clinical Hospital Project funded in 2003 by a public national grant. Dr. Quan was supported by a Post-Doctoral Fellowship from the National Health and Medical Research Council of Australia. The authors would like to acknowledge the assistance of the Centre de Recherche Epidémiologie et Biostatistique PU-PH, Service d’information médicale, CHU de Bordeaux Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED) Université de Bordeaux, France.

Conflict of interest

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Author information

Authors and Affiliations

  1. Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Bordeaux, Bordeaux, France

    Gerald M. Y. Quan, Jean-Marc Vital, Nicholas Aurouer, Ibrahim Obeid & Vincent Pointillart

  2. Department of Radiology, Bergonié Institute, Bordeaux, France

    Jean Palussière

  3. Department of Epidemiology, ISPED, Université Victor Segalen, Bordeaux 2, France

    Abou Diallo

  4. Unité de Pathologie Rachidienne, Le Service d’Orthopédie-Traumatologie, Centre Hospitalo-Universitaire Pellegrin, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France

    Gerald M. Y. Quan & Vincent Pointillart

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  1. Gerald M. Y. Quan
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Correspondence to Vincent Pointillart.

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Quan, G.M.Y., Vital, JM., Aurouer, N. et al. Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients. Eur Spine J 20, 1970–1978 (2011). https://doi.org/10.1007/s00586-011-1867-6

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  • DOI: https://doi.org/10.1007/s00586-011-1867-6

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