TY - JOUR
T1 - Quality of life outcomes following resection of adult intramedullary spinal cord tumors
AU - Xiao, Roy
AU - Miller, Jacob A.
AU - Abdullah, Kalil G.
AU - Lubelski, Daniel
AU - Mroz, Thomas E.
AU - Benzel, Edward C.
N1 - Publisher Copyright:
© 2015 by the Congress of Neurological Surgeons.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - BACKGROUND: Intramedullary spinal cord tumors 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 in adults. OBJECTIVE: To investigate QOL outcomes after intramedullary spinal cord tumors resection. METHODS: A consecutive retrospective review of all patients who underwent intramedullary spinal cord tumors resection at a single tertiary care institution between January 2008 and December 2013 was conducted. QOL was measured by the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to identify independent predictors of outcomes. RESULTS: Among 45 patients, the most common pathology was ependymoma (60%). No significant changes between preoperative and postoperative EQ-5D, PDQ, or PHQ-9 were observed. Improvements exceeding the minimal clinically important difference occurred in 28% of patients in EQ-5D, 28% in PDQ, and 16% in PHQ-9. Worse preoperative neurological status predicted worsened EQ-5D (β -0.09, P .04) and PDQ (β 20.77, P <.01), while ependymomas predicted QOL improvement exceeding the minimal clinically important difference in PDQ (OR 14.98, P .04) and approached significance in EQ-5D (OR 43.52, P .06). Conversely, cervical tumors predicted worsened PDQ (β 18.32, P <.01) and failure to achieve EQ-5D minimal clinically important difference (OR <0.01, 95% CI <0.01-0.65, P .02). Postoperative complications, such as syrinx formation (β -0.09, P .04) and cerebrospinal fluid leak (β 13.85, P .04), predicted diminished improvement in EQ-5D and PDQ, respectively. CONCLUSION: Although resection did not significantly improve QOL, it is likely necessary to arrest QOL deterioration. Patients with better preoperative neurological status or ependymoma experienced QOL improvement, while postoperative complications negatively impacted long-term QOL.
AB - BACKGROUND: Intramedullary spinal cord tumors 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 in adults. OBJECTIVE: To investigate QOL outcomes after intramedullary spinal cord tumors resection. METHODS: A consecutive retrospective review of all patients who underwent intramedullary spinal cord tumors resection at a single tertiary care institution between January 2008 and December 2013 was conducted. QOL was measured by the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to identify independent predictors of outcomes. RESULTS: Among 45 patients, the most common pathology was ependymoma (60%). No significant changes between preoperative and postoperative EQ-5D, PDQ, or PHQ-9 were observed. Improvements exceeding the minimal clinically important difference occurred in 28% of patients in EQ-5D, 28% in PDQ, and 16% in PHQ-9. Worse preoperative neurological status predicted worsened EQ-5D (β -0.09, P .04) and PDQ (β 20.77, P <.01), while ependymomas predicted QOL improvement exceeding the minimal clinically important difference in PDQ (OR 14.98, P .04) and approached significance in EQ-5D (OR 43.52, P .06). Conversely, cervical tumors predicted worsened PDQ (β 18.32, P <.01) and failure to achieve EQ-5D minimal clinically important difference (OR <0.01, 95% CI <0.01-0.65, P .02). Postoperative complications, such as syrinx formation (β -0.09, P .04) and cerebrospinal fluid leak (β 13.85, P .04), predicted diminished improvement in EQ-5D and PDQ, respectively. CONCLUSION: Although resection did not significantly improve QOL, it is likely necessary to arrest QOL deterioration. Patients with better preoperative neurological status or ependymoma experienced QOL improvement, while postoperative complications negatively impacted long-term QOL.
KW - Ependymoma
KW - Intramedullary
KW - Minimal clinically important difference
KW - Multivariable regression
KW - Quality of life
KW - Spinal cord tumors
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U2 - 10.1227/NEU.0000000000001147
DO - 10.1227/NEU.0000000000001147
M3 - Article
C2 - 26600282
AN - SCOPUS:84947976314
SN - 0148-396X
VL - 78
SP - 821
EP - 828
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -