Mühlbauer M, Pfisterer W, Eyb R, Knosp E
Department of Neurosurgery, Donauspital SMZ-Ost, Vienna, Austria.
Acta Neurochir (Wien). 2000;142(11):1219-30. doi: 10.1007/s007010070018.
In noncontiguous spinal metastatic disease, anterior or combined anterior-posterior surgery is an effective treatment. The objective of this study is to investigate whether circumferential decompression through a single-stage posterior midline approach with individualized spinal reconstruction can still achieve comparable results for functional improvement and for maintenance of spinal alignment in the absence of the risks associated with the more invasive transcavitary or combined approaches.
Seventeen patients with noncontiguous spinal metastases and plasmocytomas at one or two adjacent levels were included in this series. Circumferential decompression was obtained with anterior reconstruction and posterior fixation in ten patients, and with posterior instrumentation alone in seven patients. Postoperatively the patients were prospectively followed, and their functional status and spinal alignment were periodically evaluated.
Fourteen patients died from progression of their underlying cancer. Their mean survival time was 8 months (range: 1 to 21 months). Three survivors were evaluated at 10, 4 and 3 months respectively. At one month after surgery, 14 patients (82%) showed neurological improvement. Of 10 preoperative nonambulators, seven regained walking capacity. Five patients who were ambulatory with assistance improved to full functional independence. Local tumour recurrence was recorded in one patient after subtotal vertebrectomy for a plasmocytoma at L5. No other tumour recurrences were noted. In one patient a partial loss of correction occurred at T6 - without functional deterioration, however. Spinal alignment was maintained in all other patients who became or remained ambulatory. No major intra-operative complications or peri-operative deaths occurred. CSF leakage was recorded as the most common complication in four patients.
Circumferential decompression and spinal reconstruction through a single-stage posterior midline approach is feasible and effective. The extent of surgery can be individualized by means of this technique to the patient's specific problem. In patients with limited life expectancy from metastatic neoplastic disease, the results compare favourably with the more invasive anterior or combined antero-posterior procedures.
在非连续性脊柱转移性疾病中，前路手术或前后联合手术是一种有效的治疗方法。本研究的目的是探讨在不存在与更具侵入性的经腔或联合手术相关风险的情况下，通过单阶段后正中入路进行环形减压并个体化脊柱重建，是否仍能在功能改善和维持脊柱对线方面取得可比的效果。
本系列纳入了17例在一个或两个相邻节段患有非连续性脊柱转移瘤和浆细胞瘤的患者。10例患者采用前路重建和后路固定进行环形减压，7例患者仅采用后路内固定。术后对患者进行前瞻性随访，并定期评估其功能状态和脊柱对线情况。
14例患者死于潜在癌症的进展。他们的平均生存时间为8个月（范围：1至21个月）。3例幸存者分别在10个月、4个月和3个月时接受了评估。术后1个月，14例患者（82%）神经功能得到改善。术前10例不能行走的患者中，7例恢复了行走能力。5例在辅助下能够行走的患者改善为完全功能独立。1例患者在L5椎体次全切除治疗浆细胞瘤后出现局部肿瘤复发。未发现其他肿瘤复发情况。1例患者在T6出现部分矫正丢失，但功能未恶化。所有其他能够行走或仍能行走的患者脊柱对线均得以维持。未发生重大术中并发症或围手术期死亡。脑脊液漏被记录为4例患者中最常见的并发症。
通过单阶段后正中入路进行环形减压和脊柱重建是可行且有效的。借助该技术，手术范围可根据患者的具体问题进行个体化调整。对于转移性肿瘤疾病预期寿命有限的患者，该方法的效果优于更具侵入性的前路或前后联合手术。
