Spinal Unit, Department of Orthopaedic Surgery, University Hospital of Bordeaux, Bordeaux, France.
Eur Spine J. 2011 Nov;20(11):1970-8. doi: 10.1007/s00586-011-1867-6. Epub 2011 Jun 26.
There are few prospective studies on surgical outcomes and survival in patients with metastatic disease to the spine. The magnitude and duration of effect of surgery on pain relief and quality of life remains uncertain. Therefore, the aim of this clinical study was to prospectively evaluate clinical, functional, quality of life and survival outcomes after palliative surgery for vertebral metastases.
118 consecutive patients who underwent spinal surgery for symptomatic vertebral metastases were prospectively followed up for 12 months or until death. Clinical data and data from the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire were obtained pre- and post-operatively and at regular follow-up intervals.
Surgery was effective in achieving rapid improvement in axial and radicular pain, neurological deficit, sphincteric dysfunction and ambulatory status, with a complication rate of 26% and a 12 month mortality rate of 48%. Almost 50% of patients had complete resolution of back pain, radiculopathy and neurological deficit. Of the patients who were non-ambulant and incontinent, over 50% regained ambulatory ability and recovered urinary continence. The overall incidence of wound infection or breakdown was 6.8% and the local recurrence rate was 8.5%. There was a highly significant improvement in physical, role, cognitive and emotional functioning and global health status post-operatively. Greatest improvement in pain, function and overall quality of life occurred in the early post-operative period and was maintained until death or during the 12 month prospective follow-up period.
The potential for immediate and prolonged improvement in pain, function and quality of life in patients with symptomatic vertebral metastases should be considered during the decision-making process when selecting and counselling patients for surgery.
针对脊柱转移瘤患者的手术结果和生存情况，目前仅有少数前瞻性研究对此进行了探讨。手术对缓解疼痛和提高生活质量的效果的程度和持续时间仍不确定。因此，本临床研究旨在前瞻性评估姑息性脊柱转移瘤手术的临床、功能、生活质量和生存结果。
118 例因脊柱转移瘤引起症状而行脊柱手术的连续患者前瞻性随访 12 个月或直至死亡。在术前、术后和定期随访时，收集了临床数据和欧洲癌症研究与治疗组织（EORTC）QLQ-C30 问卷的数据。
手术能迅速有效缓解脊柱转移瘤患者的轴向和神经根性疼痛、神经功能缺损、括约肌功能障碍和活动能力，并发症发生率为 26%，12 个月死亡率为 48%。近 50%的患者完全缓解了背痛、根性痛和神经功能缺损。对于无法活动和尿失禁的患者，超过 50%的患者恢复了活动能力并恢复了尿控。总的伤口感染或破裂发生率为 6.8%，局部复发率为 8.5%。术后躯体、角色、认知和情绪功能以及总体健康状况有显著改善。术后早期疼痛、功能和整体生活质量得到了最大程度的改善，并一直持续到死亡或 12 个月的前瞻性随访期结束。
在选择和为手术患者提供咨询时，应考虑到脊柱转移瘤患者即时和长期缓解疼痛、功能和生活质量的潜力。
