Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200-00128, Rome, Italy.
Clin Orthop Relat Res. 2011 Mar;469(3):708-14. doi: 10.1007/s11999-010-1617-9.
Although many patients with cervical spine metastases are treated surgically, it is unknown whether certain subsets achieve better pain relief and improvement of neurologic function.
QUESTIONS/PURPOSES: (1) Does tumor removal with reconstruction improve the neurologic status? (2) Is any subset of patients more likely to have neurological recovery from palliative surgery? (3) What is the rate of surgery-related complications?
We retrospectively reviewed 46 patients who had palliative surgery for metastatic solid tumor metastases of the subaxial cervical spine. Indications were neurologic deficits, life expectancy longer than 6 months, and a Karnofsky Performance Score of 50 to 70. Surgery consisted of anterior tumor removal and reconstruction with titanium mesh cages and/or tricortical iliac crest allograft plus plate fixation or of a combined procedure with adjunctive posterior decompression and stabilization with lateral mass screw fixation. Postoperatively, neurologic Frankel score grade, Karnofsky Performance Score, and complications were recorded.
Five of 18 nonambulatory patients (Frankel B/C) became ambulatory again (Frankel D). No patients were Frankel Grade E preoperatively, whereas 19 of 46 gained Frankel Grade E after surgery. One patient worsened neurologically and died 4 months after surgery. Patients with neoplastic pachymeningitis had less neurologic recovery than those without. Complications included dural tears (three), wound infection (three), and tumor relapse at the same or an adjacent level (four). Two of these four patients had instrumentation-related complications.
Surgery improved clinical and neurologic status according to Frankel score; patients with neoplastic pachymeningitis are likely to experience less neurologic recovery.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
尽管许多颈椎转移瘤患者接受了手术治疗，但尚不清楚某些亚组患者是否能更好地缓解疼痛和改善神经功能。
问题/目的：（1）肿瘤切除和重建是否能改善神经状况？（2）是否有任何亚组患者更有可能从姑息性手术中恢复神经功能？（3）手术相关并发症的发生率是多少？
我们回顾性分析了 46 例因颈椎亚区转移瘤而行姑息性手术的患者。手术适应证为神经功能障碍、预期寿命超过 6 个月以及 Karnofsky 表现评分为 50-70。手术包括前路肿瘤切除和钛网笼和/或三叶髂嵴同种异体骨重建加板固定，或联合后路减压和侧块螺钉固定辅助稳定。术后记录神经 Frankel 评分、Karnofsky 表现评分和并发症。
18 例不能行走的患者中有 5 例（Frankel B/C）再次能够行走（Frankel D）。术前无 Frankel E 级患者，46 例中有 19 例术后获得 Frankel E 级。1 例患者术后神经功能恶化并于 4 个月后死亡。患有肿瘤性硬脑膜炎的患者神经恢复较少。并发症包括硬脑膜撕裂（3 例）、伤口感染（3 例）和同一或相邻水平肿瘤复发（4 例）。其中 4 例中有 2 例患者发生与器械相关的并发症。
根据 Frankel 评分，手术改善了临床和神经状况；患有肿瘤性硬脑膜炎的患者可能会经历较少的神经恢复。
IV 级，治疗研究。欲了解完整的证据水平描述，请参见作者指南。
