Tangpatanasombat Chatree, Sanpakit Sanyapong, Suratkarndawadee Sumeth, Wattanaapisit Thanet, Chotigavanichaya Chatupon
Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2012 Sep;95 Suppl 9:S87-94.
The surgical treatment of spinal metastases remains controversial. Increasing life expectancy has resulted in greater interest in overall quality of life, pain and neurologic improvements. There are few prospective studies on functional and quality of life outcomes in patients with vertebral metastases. Therefore, the authors conducted the prospective study evaluating the clinical, neurologic function and quality of life after surgery in these patients.
Fifty-two patients undergoing surgical treatment for spinal metastases during October 2007 to October 2009 were prospectively evaluated. Surgical intervention included neurological decompression,fusion and spinal instrumentation. Pre- and post-operative assessments at 1st month, 3rd month and 6th month were performed using a visual analog scale, the modified Frankel grade classification and a Shortform-36 (SF-36).
Pain scores were improved significantly at all post-operative time points (p < 0.001). The neurological functions were improved at 1st month (p < 0.001), 3rd month (p < 0.001) and 6th month (p = 0.260) postoperatively. At 1st month after surgery, 40 patients (76.9%) had improvement in quality of life. However, at 3rd month postoperatively, there were 31 patients (59.6%) improved. At 6th month postoperatively, only 15 patients (28.8%) were improved. Internal organ metastases was the only factor that related to the reduction of quality of life at 1 month, 3rd month (p < 0.001) and 6th month (p < 0.05).
Patients with spinal metastases will have benefit from palliative surgery in significant pain reduction and neurological recovery. As the global assessment in the quality of life, the patients may have the improvement at 1st month postoperatively but after 3 months and 6 months postoperatively, selected patients may have benefit from the surgery and the factors such as internal organ metastases and primary site of cancer have great effects on the improvement in the quality of life. This data may be useful for counseling the patients and relatives about the prognosis and expected surgical outcome before surgical intervention is decided.
脊柱转移瘤的外科治疗仍存在争议。预期寿命的延长使得人们对总体生活质量、疼痛及神经功能改善的关注度更高。关于椎体转移瘤患者功能及生活质量结局的前瞻性研究较少。因此，作者开展了一项前瞻性研究，评估此类患者术后的临床、神经功能及生活质量。
对2007年10月至2009年10月期间接受脊柱转移瘤手术治疗的52例患者进行前瞻性评估。手术干预包括神经减压、融合及脊柱内固定。在术后第1个月、第3个月和第6个月，使用视觉模拟量表、改良Frankel分级分类法及简短健康调查问卷（SF-36）进行术前及术后评估。
术后各时间点疼痛评分均显著改善（p < 0.001）。术后第1个月（p < 0.001）、第3个月（p < 0.001）和第6个月（p = 0.260）神经功能得到改善。术后第1个月，40例患者（76.9%）生活质量有所改善。然而，术后第3个月，有31例患者（59.6%）得到改善。术后第6个月，仅有15例患者（28.8%）得到改善。内脏转移是与术后1个月、第3个月（p < 0.001）和第6个月（p < 0.05）生活质量下降相关的唯一因素。
脊柱转移瘤患者将从姑息性手术中显著减轻疼痛及恢复神经功能中获益。作为生活质量的整体评估，患者术后第1个月可能有所改善，但术后3个月和6个月，部分患者可能从手术中获益，而内脏转移和癌症原发部位等因素对生活质量的改善有很大影响。这些数据可能有助于在决定手术干预前为患者及其家属提供有关预后和预期手术结果的咨询。
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