预测继发于恶性脊髓压迫症的神经功能缺损患者术后的神经功能恢复：系统评价
Predicting Neurologic Recovery after Surgery in Patients with Deficits Secondary to MESCC: Systematic Review.
作者信息
Laufer Ilya, Zuckerman Scott L, Bird Justin E, Bilsky Mark H, Lazáry Áron, Quraishi Nasir A, Fehlings Michael G, Sciubba Daniel M, Shin John H, Mesfin Addisu, Sahgal Arjun, Fisher Charles G
机构信息
Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN.
出版信息
Spine (Phila Pa 1976). 2016 Oct 15;41 Suppl 20(Suppl 20):S224-S230. doi: 10.1097/BRS.0000000000001827.
STUDY DESIGN
Systematic literature review and expert survey OBJECTIVE.: The aim of this study was to determine factors associated with neurologic improvement in patients with neurologic deficits secondary to metastatic epidural spinal cord compression (MESCC). Clear understanding of these factors will guide surgical decision-making by helping to elucidate which patients are more likely to benefit from surgery and how surgeons can increase the probability of neurologic and functional restoration.
SUMMARY OF BACKGROUND DATA
Surgical spinal cord decompression has been shown to improve neurologic function in patients with symptomatic MESCC. However, prognostication of neurologic improvement after surgery remains challenging, owing to sparse data and complexity of these patients.
METHODS
PubMed and Embase databases were searched for relevant publications. PRISMA Statement guided publication selection and data reporting. GRADE guidelines were used for evidence quality evaluation and recommendation formulation.
RESULTS
Low-quality evidence supports the use of the duration and severity of neurologic deficit as predictors of neurological recovery in patients with MESCC. Low-quality evidence supports the use of thoracic level of compression and previous irradiation as adverse predictors of neurological recovery. Nearly all of the AOSpine Knowledge Forum Tumor members who responded to the survey agreed that ambulation with assistance represented a successful surgical result and that duration of ambulation loss and the severity of weakness should be considered when trying to predict whether surgery would result in restoration of ambulation.
CONCLUSIONS
Review of literature and expert opinion support the importance of duration of ambulation loss and the severity of neurologic deficit (muscle strength, bladder function) in prediction of neurologic recovery among patients with symptomatic MESCC. Efforts to reduce the duration of ambulation loss and to prevent progression of neurologic deficits should be made to improve the probability of neurologic recovery.
LEVEL OF EVIDENCE
研究设计
系统文献综述与专家调查
目的
本研究旨在确定转移性硬膜外脊髓压迫（MESCC）继发神经功能缺损患者神经功能改善的相关因素。清楚了解这些因素将有助于阐明哪些患者更可能从手术中获益，以及外科医生如何提高神经和功能恢复的可能性，从而指导手术决策。
背景数据总结
手术性脊髓减压已被证明可改善有症状的MESCC患者的神经功能。然而，由于数据稀少以及这些患者情况复杂，术后神经功能改善的预后评估仍然具有挑战性。
方法
在PubMed和Embase数据库中检索相关出版物。PRISMA声明指导出版物的选择和数据报告。GRADE指南用于证据质量评估和推荐制定。
结果
低质量证据支持将神经功能缺损的持续时间和严重程度作为MESCC患者神经恢复的预测指标。低质量证据支持将胸椎压迫水平和既往放疗作为神经恢复的不良预测指标。几乎所有回复调查的AOSpine肿瘤知识论坛成员都同意，在尝试预测手术是否会导致行走恢复时，在辅助下行走代表手术成功，应考虑行走丧失的持续时间和无力的严重程度。
结论
文献综述和专家意见支持行走丧失持续时间和神经功能缺损严重程度（肌肉力量、膀胱功能）在有症状的MESCC患者神经恢复预测中的重要性。应努力缩短行走丧失的持续时间并防止神经功能缺损进展，以提高神经恢复的可能性。
证据级别
2级
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