Chaichana Kaisorn L, Pendleton Courtney, Wolinsky Jean-Paul, Gokaslan Ziya L, Sciubba Daniel M
Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Neurosurgery. 2009 Aug;65(2):267-74; discussion 274-5. doi: 10.1227/01.NEU.0000349919.31636.05.
Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. Pathological fractures of the vertebral body in patients with MESCC are not uncommon. The goals of this study were to evaluate the effects of compression fractures on long-term neurological function, as well as understand the factors that predict the development of pathological fractures for patients with MESCC.
One hundred sixty-two patients undergoing decompressive surgery for MESCC at an academic tertiary care institution from 1995 to 2007 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to assess the effects of pathological vertebral body fractures on ambulatory outcome, whereas multivariate logistical regression analysis was used to identify factors associated with preoperative compression fractures.
Sixty and 102 patients presented with and without pathological vertebral body fractures, respectively, and MESCC. Patients were followed for a mean of 9.7 +/- 2.6 months. The presence of preoperative compression fractures was independently associated with decreased postoperative ambulatory status (odds ratio, 2.106; 95% confidence interval, 1.123-4.355; P = 0.03). This was independent of age, preoperative ambulatory status, preoperative motor deficit, duration of preoperative symptoms, immediate postoperative motor deficit, and lytic tumor appearance. The factors strongly associated with preoperative compression fractures in this study include lack of sensory deficits (P = 0.01), primary breast cancer (P = 0.008), anterior spine metastases (P = 0.005), thoracic spine involvement (P = 0.01), preoperative chemotherapy (P = 0.03), and, possibly, preoperative radiation therapy (P = 0.16).
The findings of this study may provide insight into risk stratifying as well as guiding surgical management for patients with MESCC.
转移性硬膜外脊髓压迫症（MESCC）是转移性疾病中一种相对常见且使人衰弱的并发症，常导致神经功能缺损。MESCC患者椎体病理性骨折并不少见。本研究的目的是评估压缩性骨折对长期神经功能的影响，并了解预测MESCC患者病理性骨折发生的因素。
回顾性分析了1995年至2007年在一家学术性三级医疗机构接受MESCC减压手术的162例患者。采用多变量比例风险回归分析评估病理性椎体骨折对步行结果的影响，而多变量逻辑回归分析用于确定与术前压缩性骨折相关的因素。
分别有60例和102例患者存在和不存在病理性椎体骨折及MESCC。患者平均随访9.7±2.6个月。术前存在压缩性骨折与术后步行状态下降独立相关（比值比，2.106；95%置信区间，1.123 - 4.355；P = 0.03）。这与年龄、术前步行状态、术前运动功能缺损、术前症状持续时间、术后即刻运动功能缺损及溶骨性肿瘤表现无关。本研究中与术前压缩性骨折密切相关的因素包括无感觉功能缺损（P = 0.01）、原发性乳腺癌（P = 0.008）、脊柱前方转移（P = 0.005）、胸椎受累（P = 0.01）、术前化疗（P = 0.03）以及可能的术前放疗（P = 0.16）。
本研究结果可能为MESCC患者的风险分层及手术管理提供见解。
