Introduction: Intramedullary spinal cord tumors (IMSCT) are rare but morbid pathological entities resected for prevention of permanent neurological deficit. However, little is known about quality of life (QOL) after such operations. The purpose of this study was to investigate QOL outcomes following resection of IMSCT.
Methods: A consecutive retrospective chart review of all patients with IMSCT who underwent attempted resection at a single tertiary-care institution was conducted. The clinical, operative, pathologic, and radiographic data of all patients with IMSCT were reviewed. QOL was measured by the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionaire-9 (PHQ-9).
Results: Forty-five patients were included and followed for a median of 22 months postoperatively. Median age was 49 years, with 60% males. Presenting symptoms included sensory deficit (93%), motor weakness (64%), and bowel or bladder incontinence (33%). IMSCT were either cervical (33%), cervicothoracic (18%), thoracic (40%), or conus (9%).
No significant differences were observed between preoperative and postoperative QOL at last follow-up as measured by the EQ-5D index (0.627 vs. 0.608, p=0.73), PDQ (72.10 vs. 74.73, p=0.76), and PHQ-9 (7.76 vs. 7.11, p=0.60). Gross total resection (GTR) was achieved in 69% of patients. Following resection, patients with conus IMSCT experienced improvements in PDQ (98.5 to 40.3, p=0.05) and PHQ-9 (10 to 4, p=0.08), while patients with thoracic IMSCT experienced fewer missed days from work (11.1 to 2.9, p=0.04). Multivariable regression revealed the utilization of motor evoked potentials (MEP, ß=0.099, p=0.05) and schwannomas (ß=0.361, p<0.01) to be predictive of improved postoperative EQ-5D index.
Conclusions: This study is the first to characterize QOL outcomes following attempted IMSCT resection. While resection did not significantly improve QOL, resection of these tumors is necessary to halt further QOL deterioration. Schwannomas and the utilization of MEP are associated with superior QOL outcomes.
Patient Care: Intramedullary spinal cord tumors significantly decrease patient quality of life. Without resection, they may result in permanent neurologic deficit or death. Although conventional clinical outcomes have been previously reported no studies have investigated the quality of life outcomes of surgical resection. The present study reveals that surgical resection is necessary to halt, but no reverse, quality of life deterioration. Thus, this work reinforces current practices and provides further evidence supporting surgical resection of intramedullary spinal cord tumors to preserve patient quality of life.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of intramedullary spinal cord tumor resection in preventing further quality of life deterioration.
2) Discuss, in small groups, clinical practices, such as motor evoked potential monitoring, which may yield superior quality of life outcomes following intramedullary spinal cord tumor resection.
3) Identify an effective treatment of intramedullary spinal cord tumors, which may result in significant quality of life improvements.
References: 1. Quiñones-Hinojosa A, Lyon R, Zada G, Lamborn KR, Gupta N, Parsa AT, et al. Changes in transcranial motor evoked potentials during intramedullary spinal cord tumor resection correlate with postoperative motor function. Neurosurgery 2005;56:982–92.
2. Garcés-Ambrossi GL, McGirt MJ, Mehta V a, Sciubba DM, Witham TF, Bydon A, et al. Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. J Neurosurg Spine 2009;11:591–9.
3. Shrivastava RK, Epstein FJ, Perin NI, Post KD, Jallo GI. Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis. J Neurosurg 2005;2:249–55.
4. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G. Long-term follow-up of intramedullary spinal cord tumors: A series of 202 cases. Neurosurgery 2005;56:972–9.
5. Cristante L, Herrmann HD. Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 1994;35:69–74; discussion 74–6.
6. Cooper PR. Outcome after operative treatment of intramedullary spinal cord tumors in adults: Intermediate and long-term results in 51 patients. Neurosurgery 1989;25:855–9.