Key Preoperative Clinical Factors Predicting Outcome in Surgically Treated Patients with Metastatic Epidural Spinal Cord Compression: Results from a Survey of 438 AOSpine International Members

Abstract

Accurate prediction of surgical outcomes in patients suffering from metastatic epidural spinal cord compression (MESCC) is challenging. This survey aims to obtain expert opinion on which preoperative clinical factors are the most relevant predictors of survival, neurologic, functional, and health-related quality of life (HRQoL). Members of AOSpine International were invited to participate in a 15-question electronic survey. Results from the entire sample and differences across geographic regions and between neurosurgeons and orthopedic surgeons were analyzed. Factors endorsed by over 50% of the respondents were considered key predictors. Among AOSpine members, 438 responded. The absence of visceral metastasis (n= 335; 76.48%) and the site of primary tumor (n= 228; 52.05%) were identified as important predictors for survival. Frankel/American Spinal Injury Association grade D or E and the ability to walk were common to neurologic (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). While the absence of bowel/bladder/sexual dysfunction was common to neurologic (n= 260; 59.36%) and HRQoL (n= 229; 52.28%) outcomes, a high Karnofsky/Eastern Cooperative Oncology Group performance status was common to functional (n= 237; 54.11%) and HRQoL (n= 221; 50.46%) outcomes. There was overall consistency across specialities and geographic regions. Neurosurgeons and orthopedic surgeons and respondents from different geographic regions generally identified similar preoperative clinical factors as key predictors of survival, neurologic, functional, and HRQoL outcomes in surgical MESCC patients. The results of this survey will inform the development of clinical prediction rules for survival and HRQoL in MESCC patients selected for surgery to maximize their clinical relevance.