White Andrew P, Kwon Brian K, Lindskog Dieter M, Friedlaender Gary E, Grauer Jonathan N
Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
J Am Acad Orthop Surg. 2006 Oct;14(11):587-98. doi: 10.5435/00124635-200610000-00001.
Metastatic spine disease accounts for 10% to 30% of new cancer diagnoses annually. The most frequent presentation is axial pain. A thorough spinal examination includes assessment of local tenderness, deformity, limitation of motion, and signs of nerve root or cord compression. Plain radiographs are obtained routinely; for a suspected or known malignancy, radionuclide studies are essential. Magnetic resonance imaging is more specific than bone scans. Computed tomography-guided biopsy is considered to be safe and accurate for evaluating spinal lesions. Treatment is multidisciplinary, and virtually all treatment is palliative. Management is guided by three key issues: neurologic compromise, spinal instability, and individual patient factors. Site-directed radiation, with or without chemotherapy, is the mainstay of treating painful lesions that are not impinging on neural elements. New data documenting the benefit of surgical decompression using improved techniques such as anterior approaches have amplified the role of the spine surgeon in the care of these patients.
转移性脊柱疾病占每年新发癌症诊断病例的10%至30%。最常见的表现是轴向疼痛。全面的脊柱检查包括评估局部压痛、畸形、活动受限以及神经根或脊髓受压的体征。常规进行X线平片检查；对于疑似或已知的恶性肿瘤，放射性核素检查必不可少。磁共振成像比骨扫描更具特异性。计算机断层扫描引导下的活检被认为对评估脊柱病变安全且准确。治疗是多学科的，几乎所有治疗都是姑息性的。管理由三个关键问题指导：神经功能损害、脊柱不稳定和个体患者因素。有或没有化疗的部位定向放疗是治疗未侵犯神经结构的疼痛性病变的主要方法。记录使用前路等改良技术进行手术减压益处的新数据扩大了脊柱外科医生在这些患者护理中的作用。
