Clinical presentation and outcome of patients with intradural spinal cord tumours

Nambiar, Mithun; Kavar, Bhadrakant

doi:10.1016/j.jocn.2011.05.021

Cited by 25 publications

(18 citation statements)

References 20 publications

(17 reference statements)

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“…9,11,14 Patient-rated outcome scales are rarely used to measure the outcome of spinal tumor surgery. 6,15,16 However, it is important to assess the outcome from the patient's perspective in order to gauge the influence of the disorder on the patient's quality of life and ability to function in everyday life and work, especially as many of these diseases affect patients in the 4th and 5th decades of life. 2,19 The multidimensional Core Outcome Measures Index (COMI) 12 is a very brief, patient-rated outcome instrument that measures pain, function, symptom-specific well-being, quality of life, and work/social disability associated with disorders of the spine, but without being specific to any one spinal condition.…”

mentioning

confidence: 99%

Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale

Bellut

Burkhardt

Mannion

et al. 2015

FOC

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OBJECT The aim of this study was to evaluate outcome in patients undergoing surgical treatment for intradural spinal tumor using a patient-oriented, self-rated, outcome instrument and a physician-based disease-specific instrument. METHODS Prospectively collected data from 63 patients with intradural spinal tumor were analyzed in relation to scores on the multidimensional patient-rated Core Outcome Measures Index (COMI) and the physician-rated modified McCormick Scale, before and at 3 and 12 months after surgery. RESULTS There was no statistically significant difference between the scores on the modified McCormick Scale preoperatively and at the 3-month follow-up, though there was a trend for improvement (p = 0.073); however, comparisons between the scores determined preoperatively and at the 12-month follow-up, as well as 3- versus 12-month follow-ups, showed a statistically significant improvement in each case (p < 0.004). The COMI scores for axial pain, peripheral pain, and back-related function showed a significant reduction (p < 0.001) from before surgery to 3 months after surgery, and thereafter showed no further change (p > 0.05) up to 12 months postoperatively. In contrast, the overall COMI score, “worst pain,” quality of life, and social disability not only showed a significant reduction from before surgery to 3 months after surgery (p < 0.001), but also a further significant reduction up to 12 months postoperatively (p < 0.001). The scores for work disability showed no significant improvement from before surgery to the 3-month follow-up (p > 0.05), but did show a significant improvement (p = 0.011) from 3 months to 12 months after surgery. At the 3- and 12-month follow-ups, 85.2% and 83.9% of patients, respectively, declared that the surgical procedure had helped/helped a lot; 95.1% and 95.2%, respectively, declared that they were satisfied/very satisfied with their care. CONCLUSIONS COMI is a feasible tool to use in the evaluation of baseline symptoms and outcome in patients undergoing surgery for intradural spinal tumor. COMI was able to detect changes in outcome at 3 months after surgery (before changes were apparent on the modified McCormick Scale) and on later postoperative follow-up. The COMI subdomains are valuable for monitoring the patient’s reintegration into society and the work environment. The addition of an item that specifically covers neurological deficits may further increase the value of COMI in patients with spinal tumors.

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confidence: 99%

Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale

Bellut

Burkhardt

Mannion

et al. 2015

FOC

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“…In an extensive systematic analysis on intradural spinal tumors, Harrop et al 39 concluded that a patient's preoperative neurological status is a determining factor for long-term neurological and functional outcome after surgery. Nambiar and Kavar 52 also identified lower preoperative McCormick and tumor grades and extramedullary location as independent predictors for good neurological outcome.…”

Section: Discussionmentioning

confidence: 87%

“…Although resection is considered safe and effective, 21,26,34,46,55,59,60 postoperative complications vary based on patient comorbidities, tumor location, size, and extent, as well as hospital-and surgeon-related risk factors. Several singleinstitution studies 14,27,49,52,[68][69][70][71][72] have investigated long-term outcomes and associations of various preoperative risk factors with outcomes in patients undergoing resection for intradural spine tumors. Most of these retrospective analyses, however, are limited in the generalizability of their conclusions given their inherent selection bias.…”

mentioning

confidence: 99%

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

Kalakoti

Missios

Menger

et al. 2015

FOC

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OBJECT Because of the limited data available regarding the associations between risk factors and the effect of hospital case volume on outcomes after resection of intradural spine tumors, the authors attempted to identify these associations by using a large population-based database. METHODS Using the National Inpatient Sample database, the authors performed a retrospective cohort study that involved patients who underwent surgery for an intradural spinal tumor between 2002 and 2011. Using national estimates, they identified associations of patient demographics, medical comorbidities, and hospital characteristics with inpatient postoperative outcomes. In addition, the effect of hospital volume on unfavorable outcomes was investigated. Hospitals that performed fewer than 14 resections in adult patients with an intradural spine tumor between 2002 and 2011 were labeled as low-volume centers, whereas those that performed 14 or more operations in that period were classified as high-volume centers (HVCs). These cutoffs were based on the median number of resections performed by hospitals registered in the National Inpatient Sample during the study period. RESULTS Overall, 18,297 patients across 774 hospitals in the United States underwent surgery for an intradural spine tumor. The mean age of the cohort was 56.53 ± 16.28 years, and 63% were female. The inpatient postoperative risks included mortality (0.3%), discharge to rehabilitation (28.8%), prolonged length of stay (> 75th percentile) (20.0%), high-end hospital charges (> 75th percentile) (24.9%), wound complications (1.2%), cardiac complications (0.6%), deep vein thrombosis (1.4%), pulmonary embolism (2.1%), and neurological complications, including durai tears (2.4%). Undergoing surgery at an HVC was significantly associated with a decreased chance of inpatient mortality (OR 0.39; 95% CI 0.16−0.98), unfavorable discharge (OR 0.86; 95% CI 0.76−0.98), prolonged length of stay (OR 0.69; 95% CI 0.62−0.77), high-end hospital charges (OR 0.67; 95% CI 0.60−0.74), neurological complications (OR 0.34; 95% CI 0.26−0.44), deep vein thrombosis (OR 0.65; 95% CI 0.45−0.94), wound complications (OR 0.59; 95% CI 0.41−0.86), and gastrointestinal complications (OR 0.65; 95% CI 0.46−0.92). CONCLUSIONS The results of this study provide individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics and shows a decreased risk for most unfavorable outcomes for those who underwent surgery at an HVC. These findings could be used as a tool for risk stratification, directing presurgical evaluation, assisting with surgical decision making, and strengthening referral systems for complex cases.

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“…Применению малоинвазивных доступов для удаления опухолей спинного мозга в последнее время посвящено боль-шое количество публикаций [2,8,24,33,42]. Так, F. Haji и соавт.…”

Section: Discussionunclassified

Factors affecting the outcome of surgical management for extramedullary spinal cord tumors: a multicenter study

Byvaltsev¹,

Сороковиков²,

Ларионов³

et al. 2014

Vopr. neirokhir.

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Clinical presentation and outcome of patients with intradural spinal cord tumours

Cited by 25 publications

References 20 publications

Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale

Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

Factors affecting the outcome of surgical management for extramedullary spinal cord tumors: a multicenter study

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