Quality of Life Changes After Surgery for Metastatic Spinal Disease A Systematic Review and Meta-analysis

Study Design: This was a systematic review and meta-analysis. Objective: A systematic review and meta-analysis was conducted to assess the quality of life (QoL) after open surgery for spinal metastases, and how surgery affects physical, social/family, emotional, and functional well-being. Summary of Background Data: It remains questionable to what extent open surgery improves QoL for metastatic spinal disease, it would be interesting to quantify the magnitude and duration of QoL benefits-if any-after surgery for spinal metastases. Materials and Methods: Included were studies measuring QoL before and after nonpercutaneous, open surgery for spinal metastases for various indications including pain, spinal cord compression, instability, or tumor control. A random-effect model assessed standardized mean differences (SMDs) of summary QoL scores between baseline and 1, 3, 6, or 9-12 months after surgery. Results: The review yielded 10 studies for data extraction. The pooled QoL summary score improved from baseline to 1 month (SMD=1.09, P<0.001), to 3 months (SMD=1.28, P<0.001), to 6 months (SMD=1.21, P<0.001), and to 9-12 months (SMD=1.08, P=0.001). The surgery improved physical well-being during the first 3 months (SMD=0.94, P=0.022), improved emotional (SMD=1.19, P=0.004), and functional well-being (SMD=1.08, P=0.005) during the first 6 months, and only improved social/family well-being at month 6 (SMD=0.28, P=0.001). Conclusions: The surgery improved QoL for patients with spinal metastases, and rapidly improved physical, emotional, and functional well-being; it had minimal effect on social/family well-being. However, choosing the optimal candidate for surgical intervention in the setting of spinal metastases remains paramount: otherwise postoperative morbidity and complications may outbalance the intended benefits of surgery. Future research should report clear definitions of selection criteria and surgical indication and provide stratified QoL results by indication and clinical characteristics such as primary tumor type, preoperative Karnofsky, and Bilsky scores to elucidate the optimal candidate for surgical intervention.