There are many quality of life measures that can report the patients’ view of their treatment and that can also report the cost effectiveness and the impact on the health economics of the treatment. The GSTSG have opted for the EQ-5D (the reasons for which have been outlined in a consensus statement that has been submitted for publication), a widely validated instrument in other medical and surgical conditions. Also noted in GSTSG are the visual analogue score for pain, Karnofsky, Tomita and Tokuhashi scores. All radiology, imaging and pathology are noted; the extent of the surgery is graded by the Tomita Staging System (Tomita K et al. Spine 2001; 26:298–306).
Currently, there are 12 centres in nine countries who are entering a minimum of 10 cases per year and provide six monthly follow up for as long as possible. Over the last 18 months, in excess of 300 patients have been entered on the electronic password protected database; the goal is to recruit several thousand patients.
Preliminary data reveal a wide range of surgical procedures have been employed for similar pathology, with a low operative mortality (around 4.6%) but with 18% incidence of systemic complications (such as chest infections, venous thrombosis etc). Universally, there has been a marked reduction in pain and a high level of patient independence. EQ-5D analysis has revealed significant improvement in quality of life after surgery and that this is sustained over time. Detailed results will be published soon, demonstrating the beneficial effects of modern spinal surgery, as measured by the patients themselves.
Alan Crockard is emeritus professor and David Choi is consultant neurosurgeon at the National Hospital for Neurology and Neurosurgery, London, UK
