Posterior-only approach in patients with poor general condition and spinal metastatic vertebral fracture

Health- related quality of life after surgery for spinal metastases

Background

Surgery for spinal metastases is almost always palliative and part of a multidisciplinary approach that has determined a significant increase of life expectancy in the last decade; thus, an improvement in health-related quality of life (HRQOL) is the main goal of the treatment of spinal metastases. We report here the results of a prospective study conducted with the aim of evaluating the impact of spinal surgery on HRQOL, measured by Patient-Reported Outcomes Measures (PROMs). We analyzed clinical outcomes (ambulatory status, performance status, pain, neurological status) and HRQOL scores (VAS, EQ5D, SF36) during the follow-up period and focused on factors that could affect quality of life, considering both psychological and physical issues.

Methods

169 patients (96 males, 73 females) with vertebral metastases who underwent surgery at a tertiary referral center were consecutively enrolled from August 2018 to October 2022. Clinical and surgical data were prospectively collected, and PROMs (VAS, EQ-5D and SF-36) were registered before surgery and during follow up.

Results

The overall survival was 22 months, and a 61 % survival rate was registered at 1 year follow-up. We observed a significant improvement in walking ability, general performance status, pain and HRQOL after surgery, which was maintained during the follow up. Multivariate analysis identified three independent variables, capable of influencing the trend of HRQOL after surgery: the presence of pathological fracture, the preoperative neurological status and the local recurrence of disease.

Discussion

This study confirms the effectiveness of surgery for spinal metastases in improving patients' performance status and demonstrates an overall improvement in HRQOL, which is maintained over time.