Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
Spine (Phila Pa 1976). 2009 Oct 15;34(22 Suppl):S118-27. doi: 10.1097/BRS.0b013e3181ba6d02.
Systematic review of literature.
To determine whether surgical approach and technique to be used in thoracolumbar metastases is influenced by anatomic region of the spine.
There is a significant debate about the best surgical approach for the treatment of thoracolumbar metastasis.
Two research questions below were determined through a consensus among a panel of spine experts. A systematic review of literature was conducted using Pubmed. The search terms included "spin*" and "metasta*." This was to include the terms, "metastatic," "metastasis," "metastases," "spinal," and "spine." 1. In the T2 to T5 region, what is the impact of different surgical approaches (anterior, posterior, combined anteroposterior [AP]) on local recurrence, adverse events, pain alleviation, and neurologic recovery? 2. Within the thoracolumbar spine (T6-T10; T11-L2; and L3-L5) what is the impact of different surgical approaches on outcomes as per question one. The results of the systematic review were discussed with spine oncology experts through a modified Delphi technique to arrive at treatment recommendations.
From the search terms used 5176 abstracts were found. Based on the review of these abstracts, 161 were deemed acceptable. These abstracts were reviewed according to an inclusion and exclusion criteria, leaving 60 articles. These 60 articles were reviewed in detail leaving 32 articles for inclusion. There was no level I study. There was 1 level II study, 5 level III studies, and 26 level IV studies. Most of these studies selected their approach by tumor topography. The quality of evidence was very low.
There is very low quality evidence to support the superiority of one approach over another. There is a strong recommendation for posterior or posterior-lateral approach from T2 through T5. For the T6-L5 regions of the spine we recommend either anterior, posterior, or combined anterior and posterior surgery depending on the clinical presentation, surgeon and patient preference.
文献系统回顾。
确定在胸腰椎转移中使用的手术入路和技术是否受脊柱解剖区域的影响。
对于胸腰椎转移的治疗，最佳手术入路存在很大争议。
通过一组脊柱专家的共识确定了以下两个研究问题。使用 Pubmed 进行了文献系统回顾。搜索词包括“spin*”和“metasta*”。这包括“转移性”、“转移”、“转移灶”、“脊柱”和“脊椎”等术语。1. 在 T2 到 T5 区域，不同手术入路（前路、后路、前后联合）对局部复发、不良事件、疼痛缓解和神经功能恢复的影响是什么？2. 在胸腰椎（T6-T10；T11-L2；和 L3-L5）范围内，不同手术入路对根据问题 1 得出的结果有何影响。通过改良 Delphi 技术与脊柱肿瘤专家讨论系统评价的结果，以达成治疗建议。
使用搜索词共发现 5176 篇摘要。根据对这些摘要的审查，有 161 篇被认为是可以接受的。根据纳入和排除标准对这些摘要进行了审查，留下 60 篇文章。详细审查了这 60 篇文章，留下 32 篇文章供纳入。没有一级研究。有 1 项二级研究，5 项三级研究和 26 项四级研究。这些研究大多根据肿瘤的位置选择手术入路。证据质量非常低。
几乎没有高质量的证据支持一种方法优于另一种方法。强烈建议从 T2 到 T5 采用后路或后路外侧入路。对于 T6-L5 脊柱区域，我们建议根据临床表现、外科医生和患者的偏好选择前路、后路或前后联合手术。
