Shimizu K, Shikata J, Iida H, Iwasaki R, Yoshikawa J, Yamamuro T
Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Japan.
Spine (Phila Pa 1976). 1992 Nov;17(11):1400-4. doi: 10.1097/00007632-199211000-00022.
Although the value of surgical decompression and stabilization for solitary spinal metastasis is well documented, indication for surgery for advanced multiple metastatic tumors of the spine is controversial. In this study, the clinical effect of posterior decompression and stabilization was investigated in 11 patients with advanced multiple spinal metastases with unfavorable conditions. Mean blood loss during surgery was 3000 g. Disseminated intravascular coagulation occurred in three patients. Neurologic improvement was observed in nine patients. There was no neurologic deterioration due to surgery in any patients. A measure of pain relief was obtained in all patients. However, the postoperative longevity was short and the patients died 2.5 months (on average) after operation, except in cases of breast cancer. The effect of the posterior surgery on multiple spinal metastases depended on primary diseases. In cases of short life expectancy, the effect of the surgery was limited only to the short duration of neurologic improvement, pain relief, and ease of nursing care while confronted with grave surgical morbidity. In cases of long life expectancy with tumors like breast cancer, however, posterior decompression and stabilization were expected to exert long-term therapeutic effect. Therefore, the posterior surgery for multiple spinal metastases is cautiously indicated considering the nature of the primary tumor.
尽管手术减压和稳定术对孤立性脊柱转移瘤的价值已有充分文献记载，但对于晚期脊柱多发转移瘤的手术指征仍存在争议。在本研究中，对11例病情不佳的晚期脊柱多发转移瘤患者进行了后路减压和稳定术的临床疗效研究。手术期间平均失血量为3000克。3例患者发生弥散性血管内凝血。9例患者神经功能得到改善。所有患者均未因手术出现神经功能恶化。所有患者疼痛均得到一定程度缓解。然而，术后生存期较短，除乳腺癌患者外，患者术后平均2.5个月死亡。后路手术对脊柱多发转移瘤的疗效取决于原发疾病。对于预期寿命较短的患者，手术效果仅限于短期内神经功能改善、疼痛缓解以及在面对严重手术并发症时便于护理。然而，对于像乳腺癌这类预期寿命较长的肿瘤患者，后路减压和稳定术有望发挥长期治疗效果。因此，考虑到原发肿瘤的性质，对于脊柱多发转移瘤的后路手术应谨慎选择。
