Abstract
Study Design: Prospective case series of patients with tumour involvement of the spinal column consecutively admitted to a spinal unit for consideration of surgical treatment.
Objectives: To assess the impact of surgery on the quality of the life of patients suffering from metastatic or primary tumours of spine. Pre-operative assessment included the SF-36 and Oswestry Disability Index (ODI). Other scores (eg Tokuhashi) were prospectively calculated but were not used to determine suitability for surgery.
Subjects: A total of 38 patients were assessed. Of these 25 were considered suitable for surgery. Of these 25 patients, 3 died within 3 months and one had incomplete follow-up. The remaining 21 patients underwent further assessment at 3 and 6 months. A total of 8 patients are now dead in this group. Of 13 non-operated patients, one was unable to do an initial self-assessment. Of the other 12 patients, 4 were dead before second assessment. The remaining 8 patients provided us with another self-assessment. A total of 5 patients are now dead in this group.
Outcome measures: The SF-36 and ODI were repeated at 3 and 6 months. Those patients who were not considered suitable for surgery were also reassessed at 3 and 6 months, although the groups were not strictly comparable.
Results: At the time of presentation, most of the patients were severely or completely disabled. As expected, their Physical and Mental Health Component Scores of SF-36 were lower than reference values for patients with chronic ill health. The mean Bodily Pain scores were 12.84 in the operated group and 31.19 in the group managed conservatively. The initial ODI were 57 in the operated group and 59 in the conservative group. Of 25 patients who underwent surgery, 15 had posterior stabilisation and 7 had anterior reconstruction. 1 patient had a combined approach. 1 patient was stabilized with a halo vest and another had his procedures abandoned. Pre-operative and postoperative scores were compared using a paired two tail students t test. Mean Oswestry scores showed significant improvement at the 3rd month (from 57 to 48, p=0.02) and this was maintained at the 6th month. Among the various components of the SF-36 score, the most significant improvement was seen in Bodily Pain (from 12.8 to 46.8, p=0.00006). This was also maintained at 6 months. The mean Mental component scores improved significantly at the 3rd month (from 39.5 to 48, p=0.0009) and remained improved at the 6th month (44). In the non-operated group, the situation deteriorated in all respects. Mean Bodily pain scores (from 31.16 to 14.63, p=0.001), Physical component scores (from 28.48 to 19.72, p= 0.007) & Mental component scores (from 46.41 to 38.83, p= 0.05) were all significantly worse than at the initial assessment. The mean Oswestry disability score, also showed increasing disability (from 57 to 73.5) but did not reach statistical significance (p=0.16).
Conclusions: Surgery in these patients leads to a less painful and less disabled life. The quality of life improved in terms of mental health and physical health.
These abstracts were prepared by Mr. Brian J C Freeman FRCS (Tr & Orth). Correspondence should be addressed to him at The Centre for Spinal Studies and Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 2UH.
