Kim Pius, Kim Seok Won
Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea.
J Korean Neurosurg Soc. 2017 Mar;60(2):189-194. doi: 10.3340/jkns.2016.0909.003. Epub 2017 Mar 1.
We evaluated the validity of bone cement-augmented percutaneous screw fixation for treating malignant spinal metastases.
Between 2011 and 2015, 14 patients (eight men and six women) who underwent bone cement-augmented percutaneous screw fixation for malignant spinal metastases were enrolled in this study. Their life expectancy was considered to be more than one month and less than one year, based on the revised Tokuhashi scoring system. Clinical findings including the back pain scale score, functional outcome, procedure related complications, and survival were assessed preoperatively, postoperatively, and then six months after the procedure.
Twelve of the patients (86%) survived up to six months after the procedure. Three required mini-open decompressive laminectomy for severe epidural compression. Bone cement-augmented percutaneous screw fixation was performed one level above, one level below, and at the pathologic level itself. The mean operation time was 60 minutes (45-180) and blood loss was less than 100 mL. Prior to surgery, the mean pain score on the visual analogue scale was 8.8, while one month after the procedure, it had reduced to 3.0; this improvement was maintained until the six-month assessment in the surviving patients. All patients were able to sit within the first two days after surgery, and no patient experienced neurological deterioration at the one-month follow up after the surgery. No patient experienced screw loosening during the six months of follow-up. Asymptomatic cement leakage into the epidural space was observed in two patients, but no major complications were observed.
For selected patients with malignant spinal metastases, bone cement-augmented percutaneous screw fixation can provide significant pain relief and improve quality of life.
我们评估了骨水泥增强经皮螺钉固定治疗恶性脊柱转移瘤的有效性。
2011年至2015年间，14例接受骨水泥增强经皮螺钉固定治疗恶性脊柱转移瘤的患者（8例男性和6例女性）纳入本研究。根据修订的Tokuhashi评分系统，他们的预期寿命被认为超过1个月且少于1年。在术前、术后以及术后6个月评估包括背痛量表评分、功能结果、手术相关并发症和生存率等临床指标。
12例患者（86%）术后存活至6个月。3例因严重硬膜外压迫需要进行微创减压椎板切除术。骨水泥增强经皮螺钉固定在病变节段及其上下各一个节段进行。平均手术时间为60分钟（45 - 180分钟），失血量少于100毫升。术前视觉模拟量表的平均疼痛评分为8.8，而术后1个月降至3.0；在存活患者中，这种改善一直维持到6个月评估时。所有患者术后前两天内都能坐起，术后1个月随访时无患者出现神经功能恶化。随访6个月期间无患者出现螺钉松动。2例患者观察到无症状的骨水泥渗漏至硬膜外间隙，但未观察到重大并发症。
对于选定的恶性脊柱转移瘤患者，骨水泥增强经皮螺钉固定可显著缓解疼痛并改善生活质量。
