Introduction: While studies indicate that combined surgery and radiotherapy provides optimal neurological recovery in patients with epidural spinal cord compression (MESCC), the impact on functional and quality of life outcomes is unclear.
Methods: To date, 155 patients with solitary symptomatic MESCC have been enrolled in a prospective multi-center cohort study and followed for 12 months. Outcomes were assessed using metrics to evaluate neurological function (ASIA), pain (VAS); spinal status (Oswestry Disability Index: ODI) and quality of life (EQ5D, SF36).
Results: The average age was 58 years (range 29-85) with 58% males. Common primary sites were lung (23%), breast (14%), prostate (14%) and kidney (12%). 43% of the subjects were ASIA grade “E”; 37% “D”; 15% “C”, 2% “B” and, 2% “A”. Median survival was 213 days (95% CI 133—299 days). 32% survived 12 months or more. Survival was strongly associated with the site of the primary neoplastic disease (P < .05). About 62% of patients with breast cancer and only 14% of patients with lung cancer survived 12 months. Patients who survived 3 months experienced significant improvement in pain, function and health utility. At 3 months, Pain VAS improved for 1.9 (SD 3.1) (P < .05) and, ODI for 16.6 (SD 28.6) (P < .01) and EQ5D .16 (SD .30) (P < .01). The gains in EQ5D, ODI and VAS Pain were maintained in patients who survived 6 months.
Conclusions: Surgically treated patients with MESCC are a diverse group with different prognoses. Survival prognosis is associated with type of primary cancer. The surviving patients experience clinically relevant symptoms improvement and gains in function and utility. Our analysis supports use of surgery in patients with survival expectancy of 3 months or more.
Patient Care: This research is important to improve treatment protocols in patients with MESCC.
Learning Objectives: The objective of this study is to evaluate the impact of surgery on improving quality of life outcomes in the setting of MESCC.