Klimo Paul, Kestle John R, Schmidt Meic H
Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
Neurosurg Focus. 2003 Nov 15;15(5):E1. doi: 10.3171/foc.2003.15.5.1.
Spinal cord compression is one of the most dreaded complications of metastatic cancer. It can lead to a number of sequelae, including pain, spinal instability, neurological deficits, and a reduction in the patient's quality of life. Except in selected circumstances, treatment is palliative. Treatment options include surgery, radiation, and chemotherapy. The goal of this study was to summarize the existing data on the outcomes of various treatment methods for metastatic spinal epidural disease and to make appropriate recommendations for their use.
The authors used a search strategy that included an electronic database search, a manual search of journals, analysis of bibliographies in relevant review papers, and consultation with the senior author. There is good evidence, including Class I data, that steroid drugs constitute a beneficial adjunctive therapy in patients with myelopathy from epidural compression. Historically, conventional radiation therapy has been viewed as the first-line treatment because it has been shown to be as effective as a decompressive laminectomy, with a lower incidence of complications (Class II data). Nevertheless, in the last 20 years there has been remarkable progress in surgical techniques and technology. Currently, the goals of surgery are to achieve a circumferential decompression of the spinal cord, and to reconstruct and immediately stabilize the spinal column. Results in a large body of literature support the belief that surgery is better at retaining or regaining neurological function than radiation and that surgery is highly effective in relieving pain. Most of the data on the treatment of metastatic spinal disease are Class II or III, but the preliminary results of a well-designed, randomized controlled trial in which surgery is compared with standard radiation therapy represents the first Class I data.
As the number of treatment options for metastatic spinal disease has grown, it has become clear that effective implementation of these treatments can only be achieved by a multidisciplinary approach.
脊髓压迫是转移性癌症最可怕的并发症之一。它可导致多种后遗症，包括疼痛、脊柱不稳定、神经功能缺损以及患者生活质量下降。除特定情况外，治疗为姑息性的。治疗选择包括手术、放疗和化疗。本研究的目的是总结关于转移性脊柱硬膜外疾病各种治疗方法结果的现有数据，并对其使用提出适当建议。
作者采用了一种检索策略，包括电子数据库检索、期刊手工检索、分析相关综述论文中的参考文献以及与资深作者协商。有充分证据，包括I类数据，表明类固醇药物对硬膜外压迫所致脊髓病患者是一种有益的辅助治疗。从历史上看，传统放疗一直被视为一线治疗方法，因为它已被证明与减压性椎板切除术效果相同，且并发症发生率较低（II类数据）。然而，在过去20年里，手术技术和科技取得了显著进展。目前，手术的目标是实现脊髓的环形减压，并重建和立即稳定脊柱。大量文献中的结果支持这样一种观点，即手术在保留或恢复神经功能方面比放疗更好，且手术在缓解疼痛方面非常有效。关于转移性脊柱疾病治疗的大多数数据为II类或III类，但一项精心设计的将手术与标准放疗进行比较的随机对照试验的初步结果代表了首个I类数据。
随着转移性脊柱疾病治疗选择的增加，很明显只有通过多学科方法才能有效实施这些治疗。
