Yin Huabin, Zhang Dan, Wu Zhipeng, Yang Xinghai, Jiao Jian, Wan Wei, Huang Quan, Zhou Wang, Wang Ting, Jianru Xiao
Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai 200003, China.
Spine J. 2014 Aug 1;14(8):1622-8. doi: 10.1016/j.spinee.2013.09.042. Epub 2013 Oct 23.
Desmoplastic fibroma (DF) is a benign, yet locally aggressive, tumor of the connective tissue. Desmoplastic fibroma in the spine is extremely rare, and only a few cases have been reported. Although surgical resection of DF arising in the spine is commonly regarded as a recommended treatment, it is difficult to achieve satisfactory results.
This study reviews the clinical patterns and follow-up data of patients with DF in the spine who underwent surgical treatment. We attempted to correlate surgical treatment and outcomes over time.
A retrospective clinical study of the surgical managements, including subtotal resection, total spondylectomy, and en bloc resection, for DF in the spine. Desmoplastic fibroma of the spine treatment occurred from 2004 to 2009 at the Department of Bone Tumor Surgery, AA Hospital.
Twelve consecutive cases of DF of the spine underwent surgical treatment at our center between 2004 and 2009.
Neurologic outcomes were evaluated using Frankel score system and recurrence and metastasis were evaluated by computed tomography or magnetic resonance imaging of the surgical segments involved. Imaging was performed 3, 6, and 12 months after surgery, every 6 months for the next 2 years, and then annually for life.
Overall, two different surgery protocols were applied. One protocol involved subtotal resection followed by radiotherapy (n=4), whereas the other involved total tumor resection (n=8). Postoperative radiotherapy was administered in six cases. Clinical data and surgery efficacy were analyzed via chart review.
Eleven patients were disease-free during their follow-up period, whereas one patient experienced recurrence without metastasis. Radicular pain nearly disappeared, and patients suffering from spinal cord compression recovered well. Local recurrence was detected in one-fourth (25%) of the cases that underwent subtotal resection and was not detected in any of the cases involving total spondylectomy.
Local recurrence of DF is not uncommon after insufficient removal. Therefore, total excision, while also preserving neural function, is recommended. In our study, patients who underwent a total spondylectomy had significantly lower local recurrence rates for DF in the spine. Radiotherapy may be an acceptable alternative therapy, whereas en bloc resection has the potential to result in significant functional impairment.
促结缔组织增生性纤维瘤（DF）是一种良性但具有局部侵袭性的结缔组织肿瘤。脊柱促结缔组织增生性纤维瘤极为罕见，仅有少数病例报道。尽管手术切除脊柱DF通常被视为推荐治疗方法，但难以取得满意效果。
本研究回顾接受手术治疗的脊柱DF患者的临床模式和随访数据。我们试图将手术治疗与长期疗效相关联。
对脊柱DF手术治疗（包括次全切除、全脊椎切除术和整块切除）的回顾性临床研究。2004年至2009年期间，AA医院骨肿瘤外科对脊柱促结缔组织增生性纤维瘤进行治疗。
2004年至2009年期间，连续12例脊柱DF患者在本中心接受手术治疗。
采用Frankel评分系统评估神经功能结果，通过对受累手术节段进行计算机断层扫描或磁共振成像评估复发和转移情况。术后3个月、6个月和12个月进行影像学检查，接下来2年每6个月检查一次，此后每年检查一次。
总体上应用了两种不同的手术方案。一种方案是次全切除后放疗（n = 4），另一种是肿瘤全切除（n = 8）。6例患者接受了术后放疗。通过病历回顾分析临床数据和手术疗效。
11例患者在随访期间无疾病复发，1例患者复发但无转移。神经根性疼痛几乎消失，脊髓受压患者恢复良好。次全切除的病例中有四分之一（25%）出现局部复发，全脊椎切除的病例中未发现局部复发。
切除不充分后DF局部复发并不少见。因此，建议在保留神经功能的同时进行全切除。在我们研究中，接受全脊椎切除术的患者脊柱DF局部复发率显著较低。放疗可能是一种可接受的替代治疗方法，而整块切除有可能导致严重功能障碍。
