Stangenberg Martin, Viezens Lennart, Eicker Sven O, Mohme Malte, Mende Klaus C, Dreimann Marc
Departments of Trauma, Hand and Reconstructive Surgery, and.
Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Hospital Goettingen, Germany.
Neurosurg Focus. 2017 Aug;43(2):E3. doi: 10.3171/2017.5.FOCUS17175.
OBJECTIVE The treatment of cervical spinal metastases represents a controversial issue regarding the type, extent, and invasiveness of interventions. In the lumbar and thoracic spine, kypho- and vertebroplasties have been established as minimally invasive procedures for patients with metastases to the vertebral bodies and without neurological deficit. These procedures show good results with respect to pain reduction and low complication rates. However, limited data are available for kypho- and vertebroplasties for cervical spinal metastases. In an effort to add to existing data, the authors here present a case series of 14 patients who were treated for osteolytic metastases of the cervical spine using vertebroplasty alone or in addition to another surgical procedure involving the cervical spine in a palliative setting to reduce pain and restore stability. METHODS Fourteen patients consisting of 8 males and 6 females, with a mean age of 64.7 years (range 44-85 years), were treated with vertebroplasty at the authors' clinic between January 2015 and November 2016. In total, 25 vertebrae were treated with vertebroplasty: 10 C-2, 5 C-3, 2 C-4, 2 C-5, 3 C-6, and 3 C-7. Two patients had an additional posterior stabilization and 5 patients an additional anterior stabilization. In 13 cases, the surgical approach was a modified Smith-Robinson approach; in 1 case, the cement was injected into the corpus axis from posteriorly. Patients with osteolytic defects of the posterior wall of the vertebral body did not undergo surgery, nor did patients with neurological deficits. Preoperatively, on the 2nd day after surgery, and at the follow-up, neck pain was rated using the visual analog scale (VAS). RESULTS Twelve patients were examined at follow-up (mean 9 months). Neck pain was rated as a mean of 6.0 (range 3-8) preoperatively, 2.9 on Day 2 after surgery (range 0-5), and 0.5 at the follow-up (range 0-4), according to the VAS. The mean Neck Disability Index at follow-up was 3.6% (range 0%-18%). CONCLUSIONS Anterior vertebroplasty of the cervical spine via an anterolateral approach represents a safe and minimally invasive procedure with a low complication rate and appears suitable for reducing pain and restoring stability in cases of cervical spinal metastases. Vertebroplasties can be combined with other anterior and posterior operations of the cervical spine and, in the axis vertebra, can be performed transpedicularly from posteriorly. Thus, in cases in which the posterior wall of the vertebral body is intact, vertebroplasty represents a less invasive alternative to vertebral replacement in oncological surgery. Prospective randomized trials with a longer follow-up period and a larger patient cohort are needed to confirm the encouraging results of this case series.
目的 颈椎转移瘤的治疗在干预的类型、范围和侵入性方面是一个有争议的问题。在腰椎和胸椎，椎体后凸成形术和椎体成形术已成为治疗椎体转移瘤且无神经功能缺损患者的微创方法。这些手术在减轻疼痛和低并发症发生率方面显示出良好效果。然而，关于颈椎转移瘤的椎体后凸成形术和椎体成形术的数据有限。为了补充现有数据，作者在此呈现一组14例患者的病例系列，这些患者在姑息治疗中接受了单独椎体成形术或联合涉及颈椎的其他手术治疗颈椎溶骨性转移瘤，以减轻疼痛并恢复稳定性。
方法 2015年1月至2016年11月期间，14例患者（8例男性和6例女性，平均年龄64.7岁，范围44 - 85岁）在作者所在诊所接受了椎体成形术。总共25个椎体接受了椎体成形术：10个C - 2椎体、5个C - 3椎体、2个C - 4椎体、2个C - 5椎体、3个C - 6椎体和3个C - 7椎体。2例患者额外进行了后路稳定手术，5例患者额外进行了前路稳定手术。13例患者的手术入路为改良的Smith - Robinson入路；1例患者经后路将骨水泥注入枢椎体。椎体后壁有溶骨性缺损的患者未接受手术，有神经功能缺损的患者也未接受手术。术前、术后第2天及随访时，使用视觉模拟评分法（VAS）对颈部疼痛进行评分。
结果 12例患者接受了随访（平均9个月）。根据VAS评分，术前颈部疼痛平均评分为6.0（范围3 - 8），术后第2天为2.9（范围0 - 5），随访时为0.5（范围0 - 4）。随访时颈部功能障碍指数平均为3.6%（范围0% - 18%）。
结论 经前外侧入路的颈椎前路椎体成形术是一种安全、微创且并发症发生率低的手术，似乎适用于减轻颈椎转移瘤患者的疼痛并恢复稳定性。椎体成形术可与颈椎的其他前路和后路手术联合应用，在枢椎可经后路经椎弓根进行。因此，在椎体后壁完整的情况下，椎体成形术在肿瘤手术中是一种比椎体置换侵入性更小的选择。需要进行随访期更长、患者队列更大的前瞻性随机试验来证实该病例系列令人鼓舞的结果。
