Quality of Life and Postoperative Satisfaction in Patients with Benign Extramedullary Spinal Tumors

Abstract

Study design: Retrospective cohort study using prospectively collected registry data. Objective: The purpose of this study is to evaluate health-related quality of life (HRQOL) and postoperative satisfaction in patients with different histotypes of benign extramedullary spinal tumors (ESTs). Background: Little is known about how different histotypes influence HRQOL and postoperative satisfaction in EST patients. Materials and Methods: Patients undergoing primary benign EST surgery at 11 tertiary referral hospitals between 2017 and 2021 who completed preoperative and 1-year postoperative questionnaires were included. HRQOL assessment included the Physical Component Summary and Mental Component Summary (MCS) of Short Form-12, EuroQol 5-dimension, Oswestry/Neck Disability Index (ODI/NDI), and Numeric Rating Scales (NRS) for upper/lower extremities (UEP/LEP) and back pain (BP). Patients who answered “very satisfied,” “satisfied,” or “somewhat satisfied” on a seven-point Likert scale were considered to be satisfied with treatment. Student t-tests or Welch’s t-test were used to compare continuous variables between two groups, and one-way analysis of variance was used to compare outcomes between the three groups of EST histotypes (schwannoma, meningioma, atypical). Categorical variables were compared using the χ2 test or Fisher exact test. Results: A total of 140 consecutive EST patients were evaluated; 100 (72%) had schwannomas, 30 (21%) had meningiomas, and 10 (7%) had other ESTs. Baseline Physical Component Summary was significantly worse in patients with meningiomas (P=0.04), and baseline NRS-LEP was significantly worse in patients with schwannomas (P=0.03). However, there were no significant differences in overall postoperative HRQOL or patient satisfaction between histology types. Overall, 121 (86%) patients were satisfied with surgery. In a subgroup analysis comparing intradural schwannomas and meningiomas adjusted for patient demographics and tumor location with inverse probability weighting, schwannoma patients had worse baseline MCS (P=0.03), ODI (P=0.03), NRS-BP (P<.001), and NRS-LEP (P=0.001). Schwannoma patients also had worse postoperative MCS (P=0.03) and NRS-BP (P=0.001), with no significant difference in the percentage of satisfied patients (P=0.30). Conclusions: Patients who underwent primary benign EST resection had a significant improvement in HRQOL postoperatively, and ~90% of these patients reported being satisfied with their treatment outcomes one year after surgery. EST patients may exhibit a relatively lower threshold for postoperative satisfaction compared with patients undergoing surgery for degenerative spine conditions.