Surgical Management of Spinal Metastases: The Postoperative Quality of Life
Chatree Tangpatanasombat MD*, Sanyapong Sanpakit MD*, Sumeth Suratkarndawadee MD*, Thanet Wattanaapisit MD*, Chatupon Chotigavanichaya MD*
Affiliation : * Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : The surgical treatment of spinal metastases remains controversial. Increasing life expectancy has resulted in
greater interest in overall quality of life, pain and neurologic improvements. There are few prospective studies on functional
and quality of life outcomes in patients with vertebral metastases. Therefore, the authors conducted the prospective study
evaluating the clinical, neurologic function and quality of life after surgery in these patients.
Material and Method: Fifty-two patients undergoing surgical treatment for spinal metastases during October 2007 to
October 2009 were prospectively evaluated. Surgical intervention included neurological decompression, fusion and spinal
instrumentation. Pre- and post-operative assessments at 1st month, 3rd month and 6th month were performed using a visual
analog scale, the modified Frankel grade classification and a Shortform-36 (SF-36).
Results : Pain scores were improved significantly at all post-operative time points (p < 0.001). The neurological functions
were improved at 1st month (p < 0.001), 3rd month (p < 0.001) and 6th month (p = 0.260) postoperatively. At 1st month after
surgery, 40 patients (76.9%) had improvement in quality of life. However, at 3rd month postoperatively, there were 31 patients
(59.6%) improved. At 6th month postoperatively, only 15 patients (28.8%) were improved. Internal organ metastases was the
only factor that related to the reduction of quality of life at 1 month, 3rd month (p < 0.001) and 6th month (p < 0.05).
Conclusion : Patients with spinal metastases will have benefit from palliative surgery in significant pain reduction and
neurological recovery. As the global assessment in the quality of life, the patients may have the improvement at 1st month
postoperatively but after 3 months and 6 months postoperatively, selected patients may have benefit from the surgery and the
factors such as internal organ metastases and primary site of cancer have great effects on the improvement in the quality of
life. This data may be useful for counseling the patients and relatives about the prognosis and expected surgical outcome
before surgical intervention is decided.
Keywords : Spinal metastases, Quality of life, Outcome, Palliative surgery
