de Ruiter Godard C W, Lobatto Daniel J, Wolfs Jasper F, Peul Wilco C, Arts Mark P
Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands.
Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands.
Spine J. 2014 Sep 1;14(9):2085-93. doi: 10.1016/j.spinee.2013.12.029. Epub 2014 Jan 18.
Expandable cages are widely used to reconstruct the spine after the removal of vertebral metastases. Long-term results, however, are lacking, and there is little information on reconstruction after multilevel corpectomies.
To determine long-term outcome for reconstruction of the spine with expandable cages after single and multilevel corpectomies for spinal metastases.
A prospective cohort study of 60 consecutive patients with spinal metastases treated with expandable cages.
All patients were prospectively followed with regular clinical and radiographic evaluation. Outcome measures were the Frankel score, patients' self-reported recovery, radiological alignment of the spine, and neurologic plus biomechanical complications.
Sixty patients were treated with expandable cages in our hospital in a 5-year period with a maximum follow-up of 6 years. Single-level reconstruction was performed in 48 cases, 2-level in 8, and 3-level in 4. Postoperatively, the Frankel score had improved significantly (p=.03), the segment height had increased (p=.02), and, in severe cases of kyphosis (>20°), the regional angulation had been corrected compared with preoperatively (p<.001). Complication rate, however, was high (36.7%), in particular after multilevel reconstruction, in which three cases had to be reoperated years after the initial surgery; reasons for this were hardware failure, progressive kyphosis, and bronchial perforation. Good recovery was reported in 70% of all patients.
Expandable cages can be used successfully in reconstruction of the spine after single and multilevel corpectomies for spinal metastases. However, long-term complication rate is high. Promotion of bony fusion, prevention of soft-tissue damage, adequate posterior stabilization, and careful patient selection may reduce these complications.
可扩张椎间融合器被广泛用于椎体转移瘤切除术后的脊柱重建。然而，目前尚缺乏长期随访结果，且关于多节段椎体次全切除术后重建的信息较少。
确定可扩张椎间融合器在单节段和多节段椎体次全切除治疗脊柱转移瘤后脊柱重建的长期疗效。
对60例连续接受可扩张椎间融合器治疗的脊柱转移瘤患者进行前瞻性队列研究。
对所有患者进行前瞻性定期临床和影像学评估。观察指标包括Frankel评分、患者自我报告的恢复情况、脊柱的放射学对线以及神经和生物力学并发症。
5年间我院共60例患者接受了可扩张椎间融合器治疗，最长随访6年。单节段重建48例，双节段8例，三节段4例。术后Frankel评分显著改善（p = 0.03），节段高度增加（p = 0.02），在严重后凸畸形（>20°）的病例中，与术前相比区域角度得到矫正（p < 0.001）。然而，并发症发生率较高（36.7%），尤其是在多节段重建后，其中3例在初次手术后数年不得不再次手术；原因包括内固定失败、进行性后凸畸形和支气管穿孔。70%的患者报告恢复良好。
可扩张椎间融合器可成功用于单节段和多节段椎体次全切除治疗脊柱转移瘤后的脊柱重建。然而，长期并发症发生率较高。促进骨融合、预防软组织损伤、充分的后路稳定以及谨慎选择患者可能会减少这些并发症。
