Quality of life, pain, and psychological factors in patients undergoing surgery for primary tumors of the spine.

PURPOSE: Knowledge about quality of life (QOL), pain, and psychological factors in patients with primary tumors of the spine is limited, but is important in planning rehabilitation after surgery. Aims of this study were to assess the preoperative levels and improvement after surgery of these factors, and to identify the predictors of postoperative pain and QOL. METHODS: Patients with primary tumors undergoing spine surgery were matched for sex and age with patients with metastatic tumors. QOL was measured at baseline and three months after surgery with the physical (PCS) and mental (MCS) components SF-12 subscales, pain intensity with a numeric rating scale (NRS), depression with the Beck Depression Inventory (BDI). Preoperative SF-12, NRS, and BDI levels and differences in follow-up improvement in SF-12 and NRS were compared across samples. LASSO regressions were performed to find predictors of follow-up SF-12 and NRS. RESULTS: Patients with primary tumors showed better PCS and NRS, and similar BDI and MCS than patients with metastatic tumors. At follow-up, they showed stronger improvement in the MCS and no improvement in the PCS. All QOL scores were below those of the general population. Follow-up PCS was predicted by baseline PCS and BDI; MCS by baseline MCS; pain intensity by baseline pain intensity and BDI. CONCLUSION: Patients with primary tumors of the spine suffer from moderate levels of physical and mental impairment. Depression influences surgical outcomes.

Reliability, validity and responsiveness of the Italian version of the Foot Function Index in patients with foot and ankle diseases.

PURPOSE: The purpose of this study was to translate the Foot Function Index (FFI) into Italian, to perform a cross-cultural adaptation and to evaluate the psychometric properties of the Italian version of FFI. METHODS: The Italian FFI was developed according to the recommended forward/backward translation protocol and evaluated in patients with foot and ankle diseases. Feasibility, reliability [intraclass correlation coefficient (ICC)], internal consistency [Cronbach's alpha (CA)], construct validity (correlation with the SF-36 and a visual analogue scale (VAS) assessing for pain), responsiveness to surgery were assessed. The standardized effect size and standardized response mean were also evaluated. RESULTS: A total of 89 patients were recruited (mean age 51.8 ± 13.9 years, range 21-83). The Italian version of the FFI consisted in 18 items separated into a pain and disability subscales. CA value was 0.95 for both the subscales. The reproducibility was good with an ICC of 0.94 and 0.91 for pain and disability subscales, respectively. A strong correlation was found between the FFI and the scales of the SF-36 and the VAS with related content, particularly in the areas of physical function and pain was observed indicating good construct validity. After surgery, the mean FFI improved from 55.9 ± 24.8 to 32.4 ± 26.3 for the pain subscale and from 48.8 ± 28.8 to 24.9 ± 23.7 for the disability subscale (P < 0.01). CONCLUSIONS: The Italian version of the FFI showed satisfactory psychometric properties in Italian patients with foot and ankle diseases. Further testing in different and larger samples is required in order to ensure the validity and reliability of this score.

Wide Surgery in the Cervical Spine: Indications, Results, and Complications in a Series of 30 Patients Affected by Primary Bone Tumors.

BACKGROUND: En bloc surgery is the mainstay treatment for primary malignant bone tumors, as well as in the cervical spine. Unfortunately, literature on the topic is limited to case reports and small series. METHODS: We reviewed all patients affected by primary cervical spine bone tumors treated with en bloc surgeries from 1996 to 2016 and identified 30 eligible cases. We evaluated the clinical presentation and tumor characteristics and reported surgical results, complications, recurrence, and survival rates. RESULTS: Only 17 of 30 patients had not been previously treated at presentation. Osteosarcoma and chordoma were the most frequent tumors, and pain was reported in all cases. En bloc spondylectomy, hemispondylectomy, and posterior arch en bloc resection were performed in 16, 12, and 2 patients, respectively. The obtained margin was adequate (wide and marginal) in 60% of cases and intralesional in the remaining cases. Two deaths occurred in the immediate postoperative period. Neurological deterioration, dural tear, and dysphagia were the most frequent complications. The 5-year local recurrence-free survival was 70.4%. The recurrence rate was 38.5% and 11.7% in previously and non-previously treated patients, respectively (χ2: 2.94; P = 0.086). Overall survival at 5 years was 58% and 47% for all series and malignant tumors, respectively. CONCLUSION: Primary cervical spine bone tumors present a difficult approach. Findings suggest that patients treated with en bloc surgery show recurrence and survival rates comparable to the same tumors located in the thoracolumbar spine.