Bilsky M H, Boland P, Lis E, Raizer J J, Healey J H
Division of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Spine (Phila Pa 1976). 2000 Sep 1;25(17):2240-9,discussion 250. doi: 10.1097/00007632-200009010-00016.
Retrospective review of prospectively maintained institutional spine database.
To assess the pain, neurologic, and functional outcome of patients with metastatic spinal cord compression using a posterolateral transpedicular approach with circumferential fusion.
Patients with spinal metastases often have patterns of disease requiring both an anterior and posterior surgical decompression and spinal fusion. For patients whose concurrent illness or previous surgery makes an anterior approach difficult, a posterior transpedicular approach was used to resect the involved vertebral bodies, posterior elements, and epidural tumor. This approach provides exposure sufficient to decompress and instrument the anterior and posterior columns.
During the past 15 months, 25 patients were operated on using a posterolateral transpedicular approach. The primary indications for surgery were back pain (15 patients) and neurologic progression (10 patients). All patients had vertebral body disease, and 21 patients had high-grade spinal cord compression from epidural disease as assessed by magnetic resonance imaging. Seven patients underwent preoperative embolization for vascular tumors. In each patient, the anterior column was reconstructed with polymethyl methacrylate and Steinmann pins and the posterior column with long segmental fixation.
All patients achieved immediate stability. Pain relief was significant in all 23 patients who had had moderate or severe pain. Neurologic symptoms were stable or improved in 23 patients. One patient with an acutely evolving myelopathy was immediately worse after surgery, and one patient had a delayed neurologic worsening, progressing to paraplegia.
The posterolateral transpedicular approach provides a wide surgical exposure to decompress and instrument the anterior and posterior spine. This technique avoids the morbidity associated with anterior approaches and provides immediate stability. Vascular tumors may be removed safely after embolization. Patients can be mobilized early after surgery.
对前瞻性维护的机构脊柱数据库进行回顾性分析。
采用后外侧经椎弓根入路并环形融合术，评估转移性脊髓压迫患者的疼痛、神经功能及功能预后。
脊柱转移瘤患者的疾病情况往往需要前后路联合手术减压及脊柱融合。对于因并存疾病或既往手术导致前路手术困难的患者，采用后外侧经椎弓根入路切除受累椎体、后部结构及硬膜外肿瘤。该入路能提供足够的暴露，以对脊柱前后柱进行减压和器械操作。
在过去15个月中，25例患者采用后外侧经椎弓根入路进行手术。手术的主要指征为背痛（15例）和神经功能进展（10例）。所有患者均有椎体病变，21例经磁共振成像评估存在硬膜外病变导致的严重脊髓压迫。7例血管性肿瘤患者术前行栓塞治疗。每位患者均采用聚甲基丙烯酸甲酯和斯氏针重建前柱，长节段固定重建后柱。
所有患者均即刻获得稳定。23例有中度或重度疼痛的患者疼痛均显著缓解。23例患者神经症状稳定或改善。1例急性进展性脊髓病患者术后即刻病情恶化，1例患者出现延迟性神经功能恶化，进展为截瘫。
后外侧经椎弓根入路能提供广泛的手术暴露，对脊柱前后部进行减压和器械操作。该技术避免了前路手术相关的并发症，并能即刻获得稳定。血管性肿瘤栓塞后可安全切除。患者术后可早期活动。
