Surgical management of spinal metastases: the postoperative quality of life

The surgical treatment of spinal metastases remains controversial. Increasing life expectancy has resulted in greater interest in overall quality of life, pain and neurologic improvements. There are few prospective studies on functional and quality of life outcomes in patients with vertebral metastases. Therefore, the authors conducted the prospective study evaluating the clinical, neurologic function and quality of life after surgery in these patients.

Fifty-two patients undergoing surgical treatment for spinal metastases during October 2007 to October 2009 were prospectively evaluated. Surgical intervention included neurological decompression,fusion and spinal instrumentation. Pre- and post-operative assessments at 1st month, 3rd month and 6th month were performed using a visual analog scale, the modified Frankel grade classification and a Shortform-36 (SF-36).

Pain scores were improved significantly at all post-operative time points (p < 0.001). The neurological functions were improved at 1st month (p < 0.001), 3rd month (p < 0.001) and 6th month (p = 0.260) postoperatively. At 1st month after surgery, 40 patients (76.9%) had improvement in quality of life. However, at 3rd month postoperatively, there were 31 patients (59.6%) improved. At 6th month postoperatively, only 15 patients (28.8%) were improved. Internal organ metastases was the only factor that related to the reduction of quality of life at 1 month, 3rd month (p < 0.001) and 6th month (p < 0.05).

Patients with spinal metastases will have benefit from palliative surgery in significant pain reduction and neurological recovery. As the global assessment in the quality of life, the patients may have the improvement at 1st month postoperatively but after 3 months and 6 months postoperatively, selected patients may have benefit from the surgery and the factors such as internal organ metastases and primary site of cancer have great effects on the improvement in the quality of life. This data may be useful for counseling the patients and relatives about the prognosis and expected surgical outcome before surgical intervention is decided.