Itshayek Eyal
Department of Neurosurgery, Hadassah-Hebrew University Hospital.
Harefuah. 2013 Dec;152(12):718-9, 752.
In 2005, a Landmark study showed that direct decompressive surgery, followed by postoperative external beam radiotherapy (EBRT) is superior to EBRT alone in patients with metastatic epidural spinal cord compression (MESCC). Patients undergoing both surgery and EBRT had similar median survival but experienced longer ambulation than with EBRT alone. Additional studies have shown improvements in quality-of-life, higher cost-effectiveness, improved pain control, and higher functional status with surgery plus EBRT. Improved neurological outcome also improved the patients' ability to undergo postoperative adjuvant therapy. According to our experience, even patients over 65 or patients with aggressive primary tumors and additional metastases have benefited from surgical intervention, living longer than expected with preservation of ambulation and sphincter control until death or shortly before. Preserving ambulation is critical. With current surgical devices and techniques, patients with MESCC who present with a single area of cord compression, back pain, neurological deficit, or progressive deformity, may benefit from surgery prior to adjuvant radiation-based treatment or chemotherapy.
2005年，一项具有里程碑意义的研究表明，对于转移性硬膜外脊髓压迫症（MESCC）患者，直接减压手术联合术后体外束放射治疗（EBRT）优于单纯EBRT。接受手术和EBRT联合治疗的患者中位生存期相似，但行走时间比单纯接受EBRT的患者更长。其他研究表明，手术加EBRT可改善生活质量、提高成本效益、改善疼痛控制并提高功能状态。神经功能改善也提高了患者接受术后辅助治疗的能力。根据我们的经验，即使是65岁以上的患者或患有侵袭性原发性肿瘤及其他转移灶的患者，也从手术干预中获益，生存期超过预期，直至死亡或临终前一直保持行走能力和括约肌控制能力。保持行走能力至关重要。使用当前的手术设备和技术，出现单一脊髓压迫区域、背痛、神经功能缺损或进行性畸形的MESCC患者，在接受基于放疗的辅助治疗或化疗之前，可能从手术中获益。
