Moussazadeh Nelson, Rubin David G, McLaughlin Lily, Lis Eric, Bilsky Mark H, Laufer Ilya
Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA.
Legacy Spine & Neurological Associates, 5800 W. 10th St, Little Rock, AR, USA.
Spine J. 2015 Jul 1;15(7):1609-17. doi: 10.1016/j.spinee.2015.03.037. Epub 2015 Mar 28.
Pathologic vertebral compression fractures (VCFs) represent a major source of morbidity and diminished quality of life in the spinal oncology population. Procedures with low morbidity that effectively treat patients with pathologic fractures are especially important in the cancer population where life expectancy is limited. Vertebroplasty and kyphoplasty are often not effective for mechanically unstable pathologic fractures extending into the pedicle and facet joints. Combination of cement augmentation and percutaneous instrumented stabilization represents a minimally invasive treatment option that does not delay radiation and systemic therapy.
The objective of the study was to evaluate the safety and efficacy of cement-augmented short-segment percutaneous posterolateral instrumentation for tumor-associated VCF with pedicle and joint involvement.
Forty-four consecutive patients underwent cement-augmented percutaneous spinal fixation for unstable tumors between 2011 and 2014. Retrospective analysis of prospectively collected data, including visual analog pain scale (VAS) response score and procedural complications, was performed.
Patients with a median composite Spinal Instability Neoplastic Scale score of 10 (range=8-15) were treated with constructs spanning one to four disk spaces (median of two spaces, constituting 84% of all cases). The proportion of patients with severe pain decreased from 86% preoperatively to 0%; 65% of patients reported no referable instability pain postoperatively. There was one adjacent-level fracture responsive to kyphoplasty, and one case of asymptomatic screw pullout. Two patients subsequently required decompression in the setting of disease progression despite radiation; there was no perioperative morbidity.
Percutaneous cement-augmented posterolateral spinal fixation is a safe and effective option for palliation of appropriately selected mechanically unstable VCF that extends into pedicle and/or joint.
病理性椎体压缩骨折（VCF）是脊柱肿瘤患者发病和生活质量下降的主要原因。对于预期寿命有限的癌症患者，采用低发病率且能有效治疗病理性骨折的手术尤为重要。椎体成形术和后凸成形术对于延伸至椎弓根和小关节的机械性不稳定病理性骨折往往无效。骨水泥强化与经皮器械固定相结合是一种微创治疗选择，不会延迟放疗和全身治疗。
本研究的目的是评估骨水泥强化短节段经皮后外侧器械固定治疗累及椎弓根和关节的肿瘤相关性VCF的安全性和有效性。
2011年至2014年期间，44例连续患者接受了骨水泥强化经皮脊柱固定治疗不稳定肿瘤。对前瞻性收集的数据进行回顾性分析，包括视觉模拟疼痛量表（VAS）反应评分和手术并发症。
中位综合脊柱不稳定肿瘤量表评分为10分（范围=8-15）的患者接受了跨越1至4个椎间盘间隙的内固定治疗（中位为2个间隙，占所有病例的84%）。重度疼痛患者的比例从术前的86%降至0%；65%的患者术后报告无明显的不稳定疼痛。有1例相邻节段骨折对后凸成形术有反应，1例无症状螺钉拔出。尽管进行了放疗，但仍有2例患者在疾病进展时需要减压；无围手术期发病率。
经皮骨水泥强化后外侧脊柱固定术是一种安全有效的选择，可用于缓解适当选择且延伸至椎弓根和/或关节的机械性不稳定VCF。
