Altaf Farhaan, Weber Michael, Dea Nicolas, Boriani Stefano, Ames Christopher, Williams Richard, Verlaan Jorrit-Jan, Laufer Ilya, Fisher Charles G
Department of Orthopedics, Division of Spine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
Division of Surgery, McGill University and Montreal General Hospital, Montreal, Québec, Canada.
Spine (Phila Pa 1976). 2016 Oct 15;41 Suppl 20:S254-S261. doi: 10.1097/BRS.0000000000001819.
Systematic review and consensus expert opinion.
To provide surgeons and other health care professionals with guidelines for surgical reconstruction of metastatic spine disease based on evidence and expert opinion.
The surgical treatment of spinal metastases is controversial. Specifically two aspects of surgical reconstruction are addressed in this study: (i) choice of bone graft used during surgery for metastatic spine tumors and (ii) the design of reconstruction or construct to stabilize.
A systematic review of the available medical literature from 1980 to 2015 was conducted, and combined with consensus expert opinion from a recent survey of spine surgeons who treat metastatic spine tumors.
There is very little evidence in the literature to provide guidance on the use of bone graft in metastatic tumor reconstruction. There is little evidence in the literature to support the preferential use of one graft type over the other. Approximately, 41% of respondents said they used bone graft or bone graft substitutes to accomplish fusion. There were 17 studies that described the use of a prefabricated prosthetic, 10 studies describing the use of polymethyl methacrylate (PMMA) bone cement, and only three studies describing the use of bone graft for anterior column reconstruction. The use of structural allograft was most popular among the experts for anterior reconstruction, followed by cage reconstruction, and PMMA bone cement.
Achieving bony union may be of importance for the maintenance of spinal stability in the long term after reconstruction. Whether bony union is required for patients with shorter life expectancies is debatable. The literature supports the use of anterior reconstruction with either a prefabricated prosthetic or PMMA bone cement. It also supports the use of an anterior construct reinforced with bilateral posterior instrumentation when performing a three-column reconstruction.
N/A.
系统评价与专家共识意见。
基于证据和专家意见，为外科医生及其他医疗保健专业人员提供转移性脊柱疾病手术重建的指南。
脊柱转移瘤的外科治疗存在争议。本研究具体探讨了手术重建的两个方面：（i）转移性脊柱肿瘤手术中使用的骨移植材料的选择；（ii）用于稳定的重建或结构设计。
对1980年至2015年的现有医学文献进行系统评价，并结合近期对治疗转移性脊柱肿瘤的脊柱外科医生的调查所形成的专家共识意见。
文献中几乎没有证据可指导转移性肿瘤重建中骨移植材料的使用。也几乎没有证据支持优先使用某种移植类型而非其他类型。约41%的受访者表示他们使用骨移植材料或骨移植替代物来完成融合。有17项研究描述了预制假体的使用，10项研究描述了聚甲基丙烯酸甲酯（PMMA）骨水泥的使用，仅有3项研究描述了使用骨移植材料进行前柱重建。在专家中，结构性同种异体骨用于前路重建最受欢迎，其次是椎间融合器重建和PMMA骨水泥。
实现骨融合对于重建后长期维持脊柱稳定性可能很重要。对于预期寿命较短的患者是否需要骨融合仍存在争议。文献支持使用预制假体或PMMA骨水泥进行前路重建。也支持在进行三柱重建时使用双侧后路器械加强的前路结构。
不适用。
