Introduction: Accurate prediction of surgical outcomes in patients suffering from metastatic epidural spinal cord compression (MESCC) lesion is challenging. The aim of this survey was to obtain expert opinion on which preoperative clinical factors are the most relevant predictors of survival, neurological, functional, and health-related quality of life (HRQoL) outcomes in surgical MESCC patients.
Methods: Members of AOSpine International were invited to participate in an electronic survey consisting of 15 questions. Results from the entire sample were analyzed, as well as differences across geographic regions and between neurosurgeons and orthopedic surgeons. Factors endorsed by over 50% of the respondents were considered key preoperative predictors.
Results: A total of 438 AOSpine members responded. The absence of visceral metastasis (n=335; 76.48%) and the site of primary tumor (n=228; 52.05%) were identified as key preoperative predictors for survival. Similar predictors were reported for neurological, functional and HRQoL outcomes. Frankel/ASIA grade D or E and the ability to walk were common to neurological (n=344; 78.54% and n=238; 54.34%, respectively), functional (n=269; 61.42% and n=243; 55.48%, respectively), and HRQoL outcomes (n=241; 55.02% and n=242; 55.25%, respectively); the absence of bowel/bladder/sexual dysfunction was common to neurological (n=260; 59.36%) and HRQoL outcomes (n=229; 52.28%); and a high Karnofsky/ECOG performance status was common to functional (n=237; 54.11%) and HRQoL (n=221; 50.46%) outcomes. There was overall consistency across specialties and geographic regions.
Conclusions: Based on this survey, spine specialists seem to reckon that factors associated with preserved / improved functional or neurological outcomes after MESCC surgery are also positively associated with HRQoL outcomes. Further research is required to determine the key preoperative predictors for surgical outcomes specific to survival and HRQoL, since these are critical to the decision-making process in the management of MESCC patients.
Patient Care: The results of this survey will inform the design and development of clinical prediction rules for survival and HRQoL in MESCC patients selected for surgery to maximize their clinical relevance.
Learning Objectives: Identify key survival predictive factors of survival, neurological, functional, and health related quality of life in patients surgically treated for a single level symptomatic MESCC lesion.