Ecker Robert D, Endo Toshiki, Wetjen Nicholas M, Krauss William E
Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2005 Sep;80(9):1177-86. doi: 10.4065/80.9.1177.
The vertebral column is recognized as the most common site for bony metastases in patients with systemic malignancy. Patients with metastatic spinal tumors may present with pain, neurologic deficit, or both. Some tumors are asymptomatic and are detected during screening examinations. Treatment options include medical therapy, surgery, and radiation. However, diversity of patient condition, tumor pathology, and anatomical extent of disease complicate broad generalizations for treatment. Historically, surgery was considered the most appropriate initial therapy in patients with spinal metastasis with the goal of eradication of gross disease. However, such an aggressive approach has not been practical for many patients. Now, operative intervention is often palliative, with pain control and maintenance of function and stability the major goals. Surgery is reserved for neurologic compromise, radiation failure, spinal instability, or uncertain diagnosis. Recent literature has revealed that surgical outcomes have improved with advances in surgical technique, including refinement of anterior, lateral, posterolateral, and various approaches to the anterior spine, where most metastatic disease is located. We review these surgical approaches for which a team of surgeons often is needed, including neurosurgeons and orthopedic, general, vascular, and thoracic surgeons. Overall, a multimodality approach is useful in caring for these patients. It is important that clinicians are aware of the various therapeutic options and their indications. The optimal treatment of individual patients with spinal metastases should include consideration of their neurologic status, anatomical extent of disease, general health, age, and qualilty of life.
脊柱被认为是全身恶性肿瘤患者骨转移最常见的部位。脊柱转移性肿瘤患者可能出现疼痛、神经功能缺损或两者皆有。一些肿瘤无症状，在筛查检查中被发现。治疗选择包括药物治疗、手术和放疗。然而，患者病情、肿瘤病理以及疾病的解剖范围各不相同，使得治疗的广泛概括变得复杂。从历史上看，手术被认为是脊柱转移患者最适当的初始治疗方法，目标是根除肉眼可见的疾病。然而，这种激进的方法对许多患者来说并不实际。现在，手术干预通常是姑息性的，主要目标是控制疼痛以及维持功能和稳定性。手术适用于神经功能受损、放疗失败、脊柱不稳定或诊断不明确的情况。最近的文献表明，随着手术技术的进步，手术结果有所改善，包括对前路、外侧、后外侧以及各种前路脊柱手术方法的改进，大多数转移性疾病位于前路脊柱。我们回顾这些通常需要一组外科医生（包括神经外科医生、骨科医生、普通外科医生、血管外科医生和胸外科医生）实施的手术方法。总体而言，多模式方法对护理这些患者很有用。临床医生了解各种治疗选择及其适应症很重要。脊柱转移患者的最佳治疗应包括考虑他们的神经状态、疾病的解剖范围、总体健康状况、年龄和生活质量。
