Kimura Hiroaki, Fujibayashi Shunsuke, Shimizu Takayoshi, Otsuki Bungo, Murakami Hideki, Kaido Toshimi, Uemoto Shinji, Matsuda Shuichi
*Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan †Department of Orthopedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan; and ‡Department of Hepatobiliary Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Spine (Phila Pa 1976). 2015 Aug 15;40(16):E944-7. doi: 10.1097/BRS.0000000000000930.
Case report.
We report a patient who was successfully treated with total en bloc spondylectomy (TES) for T7 metastasis after living donor liver transplantation for hepatocellular carcinoma (HCC).
Spinal metastasis from HCC has a poor prognosis. There are only a few studies on surgical outcomes of spinal metastasis from HCC. Because of the high surgical morbidity and short life expectancy in patients with HCC with spinal metastasis, TES is not considered in these patients, although several studies have reported satisfactory results for TES for some types of metastatic spinal tumors. Liver transplantation (LT) is the curative treatment option for early HCC. However, the recurrence of HCC is a possible problem after LT, although no reports on surgery for spinal metastasis following LT for HCC have been published. We report on the first case of a patient who was successfully treated with TES for T7 metastasis after living donor LT for HCC.
The patient was a 65-year-old man, who had undergone living donor LT for HCC 2 years before. His main symptom was progressive gait disturbance because of the spinal cord compression by the tumor at T7. Radiology and pathology examinations revealed a solitary metastasis at T7 with neither recurrence in the liver nor metastasis in the other organs. We performed TES using a pedicle screw system and a mesh cage filled with frozen autografts.
After surgery, the patient showed clear improvement in neurological symptoms. At 3 months after surgery, a T4 metastasis was detected with magnetic resonance imaging, and the patient was treated with heavy ion radiotherapy. He could walk without a cane and there was no evidence of recurrence at 1.5 years after surgery.
Solitary spinal metastasis of HCC may become an indication for TES if liver function improves after LT.
病例报告。
我们报告一例在接受活体肝移植治疗肝细胞癌（HCC）后，因T7转移瘤而成功接受整块全脊椎切除术（TES）的患者。
HCC脊柱转移的预后较差。关于HCC脊柱转移手术结果的研究较少。由于HCC合并脊柱转移患者手术并发症发生率高且预期寿命短，尽管有几项研究报告了TES治疗某些类型转移性脊柱肿瘤的满意结果，但这类患者不考虑行TES。肝移植（LT）是早期HCC的根治性治疗选择。然而，HCC复发是LT后可能出现的问题，尽管尚无关于HCC患者LT后脊柱转移手术的报道。我们报告首例在接受活体供肝LT治疗HCC后，因T7转移瘤而成功接受TES治疗的患者。
患者为一名65岁男性，2年前接受了活体供肝LT治疗HCC。其主要症状是由于T7肿瘤压迫脊髓导致进行性步态障碍。影像学和病理学检查显示T7有孤立性转移瘤，肝脏无复发且其他器官无转移。我们使用椎弓根螺钉系统和填充自体冷冻骨块的网笼进行了TES。
术后患者神经症状明显改善。术后3个月，磁共振成像检测到T4转移瘤，患者接受了重离子放疗。术后1.5年，他能够不用拐杖行走且无复发迹象。
如果LT后肝功能改善，HCC孤立性脊柱转移可能成为TES的指征。
5级。
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