Department of Orthopaedic and Accident Surgery, University of Nottingham, Queen's Medical Center, Nottingham, UK.
Eur Spine J. 1992 Jun;1(1):43-8. doi: 10.1007/BF00302142.
Survival analysis of 70 patients with metastatic extradural tumours of the spine is presented. The indication for surgery was rapidly progressive cord compression as a initial manifestation of a malignant disease in 28 cases (40%), a preoperatively known malignant tumour in 28 patients (40%), relapse of cord compression after previous successful radiotherapy in 10 cases (14%), instability in 3 patients (4%) and uncontrolled pain in 1 patient. In 53 procedures (76%) the level of compression was in the thoracic spine, in 9 procedures in the cervical spine (13%) and in 8 procedures in the lumbar spine (11%). All patients had developed a neural deficit before surgery. Fourteen patients (20%) were able to walk prior to surgery, 47 (67%) were paraparetic, and 9 (13%) were paraplegic. Eleven patients died in the first 2 weeks following surgery and out of 59 patients who survived, 39 patients (66%) were able to walk, 11 were paraparetic (19%), and 9 were still paraplegic (15%). Bowel and bladder dysfunction was present in 37 cases (53%) before surgery and in 16 cases (27%) after surgery. Normal sphincter control was regained after 43 (73%) procedures. Persistent back pain was present in 60 patients (86%) before surgery and in 13 patients (22%) after surgery. The mean survival time for all 70 patients was 45.6 weeks. There were 11 early deaths (16%), another 51 patients died from disseminated disease (88%), and 8 patients are still alive (11%) with a mean survival of 133 weeks. A statistically significantly shorter survival was found in patients with lung metastases when compared with the survival of patients with breast metastases and the overall survival of patients with other metastatic tumours.
现报告 70 例脊柱转移瘤的生存分析。手术指征为 28 例（40%）恶性疾病的初始表现为迅速进展的脊髓压迫，28 例（40%）术前已知恶性肿瘤，10 例（14%）为先前成功放疗后脊髓压迫复发，3 例（4%）为不稳定，1 例（1%）为无法控制的疼痛。在 53 例手术（76%）中，压迫水平位于胸段，9 例位于颈段（13%），8 例位于腰段（11%）。所有患者术前均出现神经功能障碍。术前 14 例（20%）能行走，47 例（67%）为截瘫，9 例（13%）为完全性截瘫。11 例患者在术后 2 周内死亡，59 例存活患者中，39 例（66%）能行走，11 例为不完全截瘫（19%），9 例仍为完全性截瘫（15%）。术前 37 例（53%）存在肠和膀胱功能障碍，术后 16 例（27%）存在。43 例（73%）术后恢复正常括约肌控制。术前 60 例（86%）存在持续性背痛，术后 13 例（22%）存在持续性背痛。70 例患者的平均生存时间为 45.6 周。11 例早期死亡（16%），51 例死于播散性疾病（88%），8 例仍存活（11%），平均生存时间为 133 周。与乳腺癌转移患者的生存相比，肺转移患者的生存时间明显较短，与其他转移性肿瘤患者的总体生存时间相比也较短。
