Introduction: Intramedullary spinal cord tumors (IMSCT) are rare but clinically significant entities. Resection is critical to prevent permanent neurological deficits. However, no studies have investigated the quality of life (QOL) benefit of resection. The purpose of this study was to investigate QOL outcomes following IMSCT resection.

Methods: A consecutive retrospective review of all patients who underwent IMSCT resection at a single tertiary-care institution between January 2008 and December 2013 was conducted. Multivariable regression was used to identify independent predictors of favorable or unfavorable QOL outcomes.

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 changes between preoperative and postoperative QOL were observed following resection when measured by the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), or Patient Health Questionnaire-9 (PHQ-9). QOL improvements exceeding the minimal clinically important difference (MCID) occurred in 28% of patients in EQ-5D, 28% in PDQ, and 16% in PHQ-9. Worse preoperative neurological status predicted worsened EQ-5D (ß=-0.09, p=0.04) and PDQ (ß=20.77, p<0.01), while ependymomas predicted QOL improvement exceeding the MCID in EQ-5D (OR 43.52, p=0.06) and PDQ (OR 14.98, p=0.04). Conversely, cervical tumors predicted worsened PDQ (ß=18.32, p<0.01) and failure to achieve EQ-5D MCID (OR <0.01, 95% CI <0.01-0.65, p=0.02). Postoperative complications, such as syrinx formation (ß=-0.09, p=0.04) and CSF leak (ß=13.85, p=0.04), predicted diminished improvement in EQ-5D and PDQ, respectively.

Conclusions: This study is the first to characterize QOL outcomes following attempted IMSCT resection. While resection did not significantly improve pooled QOL, resection is likely necessary to arrest progressive QOL deterioration. Certain patients with favorable clinical and pathologic characteristics may achieve clinically relevant QOL improvements.

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.

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