@article{c27027097431476095f33289f3938d62,
title = "Association of neurologic deficits with surgical outcomes and health-related quality of life after treatment for metastatic epidural spinal cord compression",
abstract = "Background: A critical knowledge gap exists regarding the impact of neurologic deficits on surgical outcomes and health-related quality of life (HRQOL) for patients surgically treated for metastatic epidural spinal cord compression (MESCC). Methods: This prospective, multicenter and international study analyzed the impact of the neurologic status on functional status, HRQOL, and postoperative survival. The collected data included the patient demographics, overall survival, American Spinal Injury Association (ASIA) impairment scale, Spinal Instability Neoplastic Score, treatment details and complications and HRQOL measures, including version 2 of the 36-Item Short Form Health Survey (SF-36v2) and version 2.0 of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). Results: A total of 239 patients surgically treated for spinal metastases were included. Six weeks after treatment, 99 of the 108 patients with a preoperative ASIA grade of E remained stable, 8 deteriorated to ASIA D, and 1 deteriorated to ASIA A. Of 55 patients with ASIA D, 27 improved to ASIA E, 27 remained stable and 1 deteriorated to ASIA C. Of 11 patients with ASIA A to C, 2 improved to ASIA E, 4 improved to ASIA D, and 5 remained stable. At the 6- and 12-week follow-up, better ASIA scores were associated with better scores on multiple SF-36v2 and SOSGOQ items. Postoperatively, patients with ASIA grades of A to D were more likely to have urinary tract infections and wound complications. Patients with a baseline ASIA grade of E or D survived significantly longer. Conclusions: Patients with neurologic deficits due to MESCC have worse HRQOL and decreased overall survival. Nevertheless, surgery can result in stabilization or improvement of neurologic function which may translate into better HRQOL. Postoperative care and follow-up are challenging for patients with neurologic deficits because they experience more complications.",
keywords = "health-related quality of life (HRQOL), neurologic deficit, spine, surgery, treatment, tumor",
author = "{for the AOSpine Knowledge Forum Tumor} and Ori Barzilai and Versteeg, {Anne L.} and Goodwin, {C. Rory} and Arjun Sahgal and Rhines, {Laurence D.} and Sciubba, {Daniel M.} and Schuster, {James M.} and Weber, {Michael H.} and Aron Lazary and Fehlings, {Michael G.} and Clarke, {Michelle J.} and Arnold, {Paul M.} and Stefano Boriani and Chetan Bettegowda and Gokaslan, {Ziya L.} and Fisher, {Charles G.} and Ilya Laufer",
note = "Funding Information: This study was organized and funded by AOSpine International through the AOSpine Knowledge Forum Tumor, a focused group of international spine oncology experts acting on behalf of AOSpine. Study support was provided directly through the AOSpine Research Department and the AO Clinical Investigation and Documentation Unit. A research grant for the current study was received from the Orthopaedic Research and Education Foundation. The University of Texas MD Anderson Cancer Center is supported by the National Institutes of Health (grant P30 CA016672). Funding Information: Anne L. Versteeg reports consulting for and reimbursement for travel and accommodations from AOSpine International. C. Rory Goodwin reports research grants from the National Institutes of Health/National Institute of Neurological Disorders and Stroke (Neurosurgeon Research Career Development Program K12 Physician Scientist Award), the North Carolina Spine Society, and Robert Wood Johnson's Harold Amos Medical Faculty Development Program. Arjun Sahgal reports past educational seminars with Elekta AB, Accuray, Inc, BrainLAB, Medtronic Kyphon, and Varian Medical Systems; a research grant from Elekta AB; advisory/consultancy roles with AbbVie, Merck, Roche, Varian (medical advisory group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (medical advisory board); and travel accommodations and expenses from BrainLAB, Elekta, and Varian. Sahgal also is a board member of the International Stereotactic Radiosurgery Society and belongs to the Elekta MR Linac Research Consortium and the Elekta Spine, Oligometastases, and Linac‐Based SRS Consortia. Laurence D. Rhines reports educational commitments to Stryker outside the submitted work. Daniel M. Sciubba reports consulting for and royalties from Medtronic, DePuy Synthes, Stryker, Nuvasive, and K2M and personal fees from Globus and Baxter outside the submitted work. Paul M. Arnold reports travel accommodations and expenses from AOSpine North America; intellectual property rights and interests in, equity from, and a position of responsibility at Evoke Medical; equity from Z‐Plasty; consulting fees from Stryker Orthopaedics, Ulrich, SpineGuard, and InVivo Therapeutics; and consulting fees, travel accommodations, and expenses from Stryker Spine, Spinewave, Medtronic outside the submitted work. Stefano Boriani reports educational commitments to K2M and Nuvasive outside the submitted work. Chetan Bettegowda reports acting as a consultant for DePuy Synthes outside the submitted work. Ziya L. Gokaslan reports research support from AOSpine North America and stock ownership of Spinal Kinetics outside the submitted work. Charles G. Fisher reports consulting for and royalties from Medtronic, personal fees from Nuvasive, research grants from the Orthopaedic Research and Education Foundation, and fellowship support paid to his institution from AOSpine and Medtronic outside the submitted work. Ilya Laufer reports receiving consulting fees from Globus, DePuy Synthes, and SpineWave and personal fees from Medtronic and BrainLAB outside the submitted work. The other authors made no disclosures. ",
year = "2019",
month = dec,
day = "1",
doi = "10.1002/cncr.32420",
language = "English (US)",
volume = "125",
pages = "4224--4231",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "23",
}