Wiedenhöfer B, Möhlenbruch M, Hemmer S, Lehner B, Klöckner K, Akbar M
Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Sektion Wirbelsäulenchirurgie, Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
Orthopade. 2012 Aug;41(8):623-31. doi: 10.1007/s00132-012-1908-9.
Metastases are responsible for most tumor manifestations of the spine. About 25% are symptomatic; however, due to interdisciplinary management the tumor-associated mortality is regressing. Associated acute spinal cord injury (SCI) syndromes raise patient morbidity with a loss of independence and quality of life associated with a fair potential for recovery. Therefore, the management is focused on the avoidance of SCI. The assessment of mechanical stability of vertebral bodies is a central part of decision-making when considering operative therapy. This review gives an update on the current evidence-based data for metastasis management.
The NOMS concept is well established. Especially the parameters origin, neurologic symptoms, stability and vascularization are described and illustrated by clinical cases.
Evidence-based operative therapy concepts are shown reflecting palliative and curative approaches.
Clinical and radiological parameters help to find the individual therapy. Generally a number of scores with significant time expenditure are needed. The spine instability neoplastic score (SINS) simplifies the management. Operative therapy shows the best results for the parameters pain and quality of life. However, potential perioperative and postoperative complications have to be estimated and should be avoided. Using these facts our therapy algorithm is helpful for therapy management.
With rising life expectancy operative therapy is of increasing relevance. Decision-making uses information about tumor origin, neurologic symptoms, stability, prognostic factors and vascularisation to determine the individual therapy.
转移瘤是脊柱大多数肿瘤表现的原因。约25%有症状；然而，由于多学科管理，肿瘤相关死亡率正在下降。相关的急性脊髓损伤（SCI）综合征会增加患者的发病率，导致患者失去独立性和生活质量下降，不过仍有一定的恢复潜力。因此，治疗重点在于避免脊髓损伤。椎体机械稳定性评估是考虑手术治疗时决策的核心部分。本综述对转移瘤治疗的当前循证数据进行了更新。
NOMS概念已得到充分确立。特别是通过临床病例对原发灶、神经症状、稳定性和血管形成等参数进行了描述和说明。
展示了基于证据的手术治疗理念，反映了姑息性和根治性方法。
临床和放射学参数有助于找到个体化治疗方案。一般来说，需要一些耗时较长的评分。脊柱不稳定肿瘤评分（SINS）简化了管理。手术治疗在疼痛和生活质量参数方面显示出最佳效果。然而，必须评估潜在的围手术期和术后并发症并应避免。基于这些事实，我们的治疗算法有助于治疗管理。
随着预期寿命的延长，手术治疗的相关性日益增加。决策制定利用有关肿瘤原发灶、神经症状、稳定性、预后因素和血管形成的信息来确定个体化治疗方案。
