To the Editor,

We read with great interest an article titled “The importance of timely treatment for quality of life and survival in patients with symptomatic spinal metastases” authored by Floris R van Tol, et al. We congratulate the authors for addressing this important topic—the timing and factors of treatment for patients with spinal metastases. PEQ-5D scores, KPS scores and mortality rates were compared between timely treated group and delayed treated group [1]. Their study drew a conclusion that the delayed treatment of patients with symptomatic spinal metastases has both direct and indirect adverse consequences for functional performance status, quality of life and survival. However, we wish to bring a point which we think is extremely relevant to the notice of this journal’s readership which would send out the message expounded in this study with more clarity.

It is of great significance to how to define timely treatment or delayed treatment? In the study, patients who underwent elective surgery were considered as timely treated, whereas patients requiring emergency surgery were considered to be treated in a delayed fashion. Three-day was chosen as the cut-off value. We hold the view that this definition of purely day-cut-off is vague and confusing. The patient's course of disease must be taken into account to determine whether treatment is timely. For example, if a patient had been diagnosed with a metastatic spine and had been suffering from chronic severe pain without any effective treatment, it was certainly definite as delayed treatment when the patient received emergency surgery for a pathological fracture. However, if a patient with no symptoms or tumor, suddenly developed lower limb paralysis, MRI shows vertebral destruction and spinal cord compression, and emergency surgery was performed to save neurological function. According to the definition of the article, this was a case of delayed treatment. On the contrary, I think the surgical treatment was very timely.

Once again, we compliment the authors for their work and hope that the readers may benefit from it.