Wu Xinghuo, Ye Zhewei, Pu Feifei, Chen Songfeng, Wang Baichuan, Zhang Zhicai, Yang Cao, Yang Shuhua, Shao Zengwu
From the Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Medicine (Baltimore). 2016 May;95(18):e3558. doi: 10.1097/MD.0000000000003558.
Increased incidence of upper cervical metastases and higher life expectancy resulted in higher operative rates in patients. The purpose of this study was to explore the methods and the clinical outcomes of palliative surgery for cervical spinal metastases.A systematic review of a 15-case series of upper cervical metastases treated with palliative surgery was performed. All cases underwent palliative surgery, including anterior tumor resection and internal fixation in 3 cases, posterior tumor resection and internal fixation in 10 cases, and combined anterior and posterior tumor resection and internal fixation in 2 cases. Patients were followed-up clinically and radiologically after the operation, and visual analog scale (VAS) and activities of daily living scores were calculated. In addition, a literature review was performed and patients with upper cervical spine metastases were analyzed.The mean follow-up period was 12.5 months (range, 3-26 months) in this consecutive case series. The pain was substantially relieved in 93.3% (14/15) of the patients after the operation. The VAS and Japanese Orthopedic Association scores showed improved clinical outcomes, from 7.86 ± 1.72 and 11.13 ± 2.19 preoperatively to 2.13 ± 1.40 and 14.26 ± 3.03 postoperatively, respectively. The mean survival time was 9.5 months (range, 5-26 months). Dural tear occurred in 1 patient. Wound infections, instrumentation failure, and postoperative death were not observed. Among our cases and other cases reported in the literature, 72% of the patients were treated with simple anterior or posterior operation, and only 12% of the patients (3/25) underwent complex combined anterior and posterior operation.Metastatic upper cervical spine disease is not a rare occurrence. Balancing the perspective of patients on palliative surgery concerning the clinical benefits of operation versus its operative risks can assist the decision for surgery.
上颈椎转移瘤发病率的增加和预期寿命的延长导致患者的手术率升高。本研究的目的是探讨颈椎转移瘤姑息性手术的方法及临床疗效。对15例接受姑息性手术治疗的上颈椎转移瘤病例系列进行了系统评价。所有病例均接受了姑息性手术，其中3例行前路肿瘤切除及内固定，10例行后路肿瘤切除及内固定，2例行前后联合肿瘤切除及内固定。术后对患者进行临床和影像学随访，并计算视觉模拟评分（VAS）和日常生活活动评分。此外，进行了文献综述并对上颈椎转移瘤患者进行了分析。
在这个连续病例系列中，平均随访时间为12.5个月（范围3 - 26个月）。术后93.3%（14/15）的患者疼痛得到明显缓解。VAS和日本骨科协会评分显示临床疗效改善，术前分别为7.86±1.72和11.13±2.19，术后分别为2.13±1.40和14.26±3.03。平均生存时间为9.5个月（范围5 - 26个月）。1例患者发生硬脑膜撕裂。未观察到伤口感染、内固定失败和术后死亡。在我们的病例以及文献报道的其他病例中，72%的患者接受了单纯前路或后路手术，只有12%的患者（3/25）接受了复杂的前后联合手术。
上颈椎转移性疾病并不罕见。在考虑手术临床益处与手术风险的情况下，平衡患者对姑息性手术的看法有助于做出手术决策。
