Tan Terence, Chu Jocelyn, Thien Christopher, Wang Yi Yuen
Department of Neurosurgery, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
J Neurol Surg A Cent Eur Neurosurg. 2017 Jul;78(4):358-367. doi: 10.1055/s-0036-1592159. Epub 2016 Sep 21.
To evaluate the feasibility, safety, clinical, and radiologic outcomes of a minimally invasive direct lateral-approach corpectomy (MIDLaC) for decompression and stabilization of symptomatic metastatic spinal cord compression (MSCC). A retrospective study on a prospective cohort was conducted. Nineteen patients were consecutively treated with MIDLaC and posterior pedicle screw fixation between May 2012 and July 2014. Demographic information and radiologic outcomes including sagittal deformity correction and vertebral body height were recorded. Operative variables (operative duration, blood loss) and clinical variables (Tokuhashi score, mortality, complication rate, pain visual analogue scale [VAS], opioid usage, and Frankel grade) were recorded and analyzed. All nineteen patients (mean age: 67.6 ± 12.7 years) successfully underwent MIDLaC with excellent neural decompression. Operative duration was 188.4 ± 30.3 minutes for single-level MIDLaC and 327.2 ± 71.9 minutes for multilevel surgery ( < 0.0001). Mean blood loss per spinal level was 390.8 mL with a decrease to 102.3 mL excluding renal cell MSCC. A total of 47.4% of patients had a Tokuhashi score of 0 to 8. There was one approach-related complication and one perioperative mortality. The overall complication rate was 15.8% ( = 3) with no postoperative wound infections. Kaplan-Meier survival estimates at 6 months were 0.50. Overall, 31.6% of patients improved by one or more Frankel grades, and no patients demonstrated worsening neurology postoperatively. VAS was significantly improved postoperatively ( < 0.05). Vertebral body height was significantly increased (+7.6 ± 8.1 mm; = 0.002), with improvements in lumbar lordosis (8.3 ± 7.3 degrees) and thoracic kyphosis (2.4 ± 7.1 degrees) postoperatively. MIDLaC is a safe and feasible palliative approach in the management of MSCC with encouraging early clinical outcomes. Further prospective studies are required to define the role of MIDLaC in the management of MSCC vis-à-vis other mini-open or minimally invasive techniques.
评估微创直接外侧入路椎体切除术（MIDLaC）用于有症状的转移性脊髓压迫症（MSCC）减压和稳定治疗的可行性、安全性、临床及影像学结果。对一个前瞻性队列进行回顾性研究。2012年5月至2014年7月期间，19例患者连续接受了MIDLaC及后路椎弓根螺钉固定术。记录人口统计学信息及影像学结果，包括矢状面畸形矫正和椎体高度。记录并分析手术变量（手术时长、失血量）及临床变量（Tokuhashi评分、死亡率、并发症发生率、疼痛视觉模拟量表[VAS]、阿片类药物使用情况及Frankel分级）。19例患者（平均年龄：67.6±12.7岁）均成功接受了MIDLaC，神经减压效果良好。单节段MIDLaC的手术时长为188.4±30.3分钟，多节段手术为327.2±71.9分钟（<0.0001）。每个脊柱节段的平均失血量为390.8 mL，排除肾细胞MSCC后降至102.3 mL。共有47.4%的患者Tokuhashi评分为0至8分。发生1例与入路相关的并发症和1例围手术期死亡。总体并发症发生率为15.8%（n = 3），无术后伤口感染。6个月时的Kaplan-Meier生存估计值为0.50。总体而言，31.6%的患者Frankel分级提高了一级或更多，且无患者术后神经功能恶化。术后VAS显著改善（<0.05）。椎体高度显著增加（+7.6±8.1 mm；P = 0.002），术后腰椎前凸（8.3±7.3度）和胸椎后凸（2.4±7.1度）也有所改善。MIDLaC是治疗MSCC的一种安全可行的姑息性方法，早期临床结果令人鼓舞。需要进一步的前瞻性研究来明确MIDLaC相对于其他微创或极小切口技术在MSCC治疗中的作用。
