Yao Kevin C, Boriani Stefano, Gokaslan Ziya L, Sundaresan Narayan
Mount Sinai Medical Center, New York, New York, USA.
Neurosurg Focus. 2003 Nov 15;15(5):E6. doi: 10.3171/foc.2003.15.5.6.
Spinal metastases are prevalent in the population of patients with cancer. Effective cancer therapy must incorporate treatment strategies for these lesions. Increasingly, surgery is being recognized as an effective treatment modality both for the patient's quality of life and potential oncological cure. En bloc spondylectomy is the surgical procedure of choice to obtain these goals. The purpose of this study was to examine critically the rationale, indications, and outcomes of en bloc spondylectomy for spinal metastases.
Outcomes in the authors' series of patients who underwent en bloc spondylectomy for spinal metastases are critically analyzed. The rationale and indications for this procedure are discussed. The Weinstein, Boriani, and Biagini surgical staging system for spinal tumors is described. A review of the literature is performed to examine further the rationale underlying this aggressive surgical approach to metastatic spinal disease.
En bloc spondylectomy is the treatment of choice for solitary and oligometastatic spinal metastaseswith biologically favorable histological findings. In appropriately selected patients, neurological outcome, pain control, and oncological control are significantly better after en bloc spondylectomy compared with radiation therapy. Oncological outcomes also exceed those of intralesional techniques. The Weinstein, Boriani, and Biagini surgical staging system provides a standard with which to plan surgical approaches and to compare surgical outcomes.
脊柱转移瘤在癌症患者群体中很常见。有效的癌症治疗必须纳入针对这些病灶的治疗策略。越来越多的人认识到，手术对于患者的生活质量和潜在的肿瘤治愈都是一种有效的治疗方式。整块脊椎切除术是实现这些目标的首选手术方法。本研究的目的是严格审视整块脊椎切除术治疗脊柱转移瘤的理论依据、适应证和疗效。
对作者所在系列接受整块脊椎切除术治疗脊柱转移瘤的患者的疗效进行严格分析。讨论该手术的理论依据和适应证。描述了用于脊柱肿瘤的温斯坦、博里亚尼和比亚吉尼手术分期系统。进行文献综述以进一步研究这种针对转移性脊柱疾病的积极手术方法的理论基础。
整块脊椎切除术是治疗具有生物学上有利组织学表现的孤立性和寡转移性脊柱转移瘤的首选方法。在适当选择的患者中，与放射治疗相比，整块脊椎切除术后的神经功能结果、疼痛控制和肿瘤控制明显更好。肿瘤学结果也超过了病灶内技术。温斯坦、博里亚尼和比亚吉尼手术分期系统提供了一个标准，可用于规划手术方法和比较手术结果。
