Zairi Fahed, Vielliard Marie-Hélène, Bouras Alkis, Karnoub Mélodie-Anne, Marinho Paulo, Assaker Richard
Department of Neurosurgery, Lille University Hospital, Lille, France -
Department of Rheumatology, Lille University Hospital, Lille, France.
J Neurosurg Sci. 2017 Aug;61(4):365-370. doi: 10.23736/S0390-5616.16.03417-2. Epub 2015 Oct 6.
The management of spine metastases is an increasing concern for spine surgeons. Their treatment is mainly palliative with the goal to preserve or restore the patients' quality of life. Many minimally invasive techniques have been introduced with the aim to reduce the morbidity associated with more traditional open approaches. We aimed to evaluate the efficiency of long segment percutaneous pedicle screw stabilization for the treatment of instability associated with symptomatic thoracolumbar spine metastases.
In this prospective study, we included all patients who underwent the percutaneous placement of pedicle screws in our institution between January 2008 and June 2014, for the palliative treatment of a symptomatic thoracolumbar spine metastasis. All patients had a normal examination. Postoperative radiation therapy was planned within 2 weeks following the stabilization. A clinical and radiological follow-up were planned at 3 months, 6 months and 1 year. Pain was measured using VAS and functional status was assessed using the Frankel Grading system. CT scan was performed before discharge and at each office evaluation.
Forty-four patients have been included. There were 26 men and 18 women, with a mean age of 57.3 years (range 36-79 years). The mean operative time was 85 minutes (range 47-124 min), and the estimated blood loss was inferior to 100 mL in all cases. The mean length of hospital stay was 5.2 days (range 3-18 days). All patients underwent postoperative radiation therapy within 2 weeks. Pain was significantly improved from the early postoperative period (P<0.001). Visual Analogic Scale scores decreased from 6.3 (2-10) to 3.0 (0-6) at discharge. No patient worsened his neurological condition postoperatively. One patient required a revision surgery at 3 months due to an important tumor progression at the treated level. Radiological follow-up demonstrated no case of misplacement, hardware breakage or loosening.
As the treatment of spine metastases is largely palliative, minimally invasive techniques should be discussed first to limit the impact of surgery in critical patients. Long-segment percutaneous screw fixation followed by early radiation therapy, appears to be a safe and effective treatment option to ensure solid and durable stability, as well as a good local tumor control.
脊柱转移瘤的治疗日益受到脊柱外科医生的关注。其治疗主要是姑息性的，目标是维持或恢复患者的生活质量。为了降低与更传统的开放手术相关的发病率，已经引入了许多微创技术。我们旨在评估长节段经皮椎弓根螺钉内固定术治疗有症状的胸腰椎脊柱转移瘤相关不稳的有效性。
在这项前瞻性研究中，我们纳入了2008年1月至2014年6月期间在我院接受经皮椎弓根螺钉置入术以姑息治疗有症状的胸腰椎脊柱转移瘤的所有患者。所有患者检查均正常。在稳定手术后2周内计划进行术后放疗。计划在术后3个月、6个月和1年进行临床和影像学随访。使用视觉模拟评分法（VAS）测量疼痛，并使用Frankel分级系统评估功能状态。出院前及每次门诊评估时均进行CT扫描。
共纳入44例患者。其中男性26例，女性18例，平均年龄57.3岁（范围36 - 79岁）。平均手术时间为85分钟（范围47 - 124分钟），所有病例估计失血量均少于100毫升。平均住院时间为5.2天（范围3 - 18天）。所有患者均在2周内接受了术后放疗。术后早期疼痛明显改善（P < 0.001）。出院时视觉模拟评分从6.3（2 - 10）降至3.0（0 - 6）。术后无患者神经功能恶化。1例患者在3个月时因治疗节段肿瘤进展严重而需要翻修手术。影像学随访显示无螺钉误置、内固定物断裂或松动病例。
由于脊柱转移瘤的治疗主要是姑息性的，应首先讨论采用微创技术以限制手术对病情严重患者的影响。长节段经皮螺钉固定术联合早期放疗似乎是一种安全有效的治疗选择，可确保稳固持久的稳定性以及良好的局部肿瘤控制。
