Cavalcante Rodrigo Ac, Fernandes Yvens B, Marques Romulo Al, Santos Vinícius G, Martins Edésio, Zaccariotti Vladimir A, Arruda João B, Tatsui Claúdio E, Joaquim Andrei F
Department of Neurology, State University of Campinas, Campinas, São Paulo, Brasil.
Department of Neuro-Oncology, Araujo Jorge Cancer Hospital, Goiânia, Goiás, Brasil.
J Craniovertebr Junction Spine. 2017 Jul-Sep;8(3):187-192. doi: 10.4103/jcvjs.JCVJS_64_17.
The decision for selecting patients for surgical treatment of metastatic spinal cord compression (MSCC) is challenging even for experienced surgeons. Recently, the spinal instability neoplastic score (SINS) has been proposed to help surgeons in the evaluation of spinal stability in the setting of spinal metastases. This study aimed to evaluate the correlation between SINS and preoperative visual analog scale (VAS), as well as the pre- and post-operative association of the VAS and neurological function.
A prospective cohort study was conducted in a tertiary referral cancer center. Seventy-nine patients with MSCC were surgically treated from June 2012 to March 2015. Pain status before and after surgery was assessed using VAS score, and neurological status was evaluated using the American Spine Injury Association Impairment Scale (AIS) before and after surgery. Pain was classified as VAS (0-4) none or mild pain; VAS (5-8) moderate pain; and VAS (9-10) as severe pain. Neurological function was scored as AIS A: Complete deficits, AIS B-D: Incomplete deficits, AIS E: Neurologically intact. SINS degrees were classified as 0-6-stable; 7-12 potentially unstable, and 13-18-unstable. Spearman's correlation coefficient test was utilized for correlation between pain and SINS; Chi-square association test was utilized for evaluating pre- and post-operative pain and AIS, as well as the association between SINS and tumor types.
A higher SINS correlates with severe mechanical pain preoperatively (ρ = 0.38, = 0.001); surgical procedure improved neurological function ( = 0.0001), and decrease pain ( = 0.84). Finally, a higher SINS was also associated with osteolytic tumors ( = 0.03).
The SINS correlates with mechanical pain. Surgery provides a significant improvement in pain and neurological status, especially in patients who presented higher SINS scores and some degree of preoperative neurological function.
即使对于经验丰富的外科医生而言，决定哪些患者适合接受转移性脊髓压迫症（MSCC）的手术治疗也颇具挑战性。最近，有人提出了脊柱不稳定肿瘤评分（SINS），以帮助外科医生评估脊柱转移情况下的脊柱稳定性。本研究旨在评估SINS与术前视觉模拟评分（VAS）之间的相关性，以及VAS与神经功能的术前和术后关联。
在一家三级转诊癌症中心进行了一项前瞻性队列研究。2012年6月至2015年3月期间，对79例MSCC患者进行了手术治疗。使用VAS评分评估手术前后的疼痛状况，并使用美国脊髓损伤协会损伤量表（AIS）评估手术前后的神经状况。疼痛分类为VAS（0-4）无或轻度疼痛；VAS（5-8）中度疼痛；VAS（9-10）为重度疼痛。神经功能评分为AIS A：完全缺损，AIS B-D：不完全缺损，AIS E：神经功能完整。SINS程度分为0-6稳定；7-12潜在不稳定，13-18不稳定。采用Spearman相关系数检验评估疼痛与SINS之间的相关性；采用卡方关联检验评估手术前后的疼痛和AIS，以及SINS与肿瘤类型之间的关联。
较高的SINS与术前严重的机械性疼痛相关（ρ = 0.38，P = 0.001）；手术改善了神经功能（P = 0.0001），并减轻了疼痛（P = 0.84）。最后，较高的SINS也与溶骨性肿瘤相关（P = 0.03）。
SINS与机械性疼痛相关。手术可显著改善疼痛和神经状况，尤其是对于SINS评分较高且术前有一定程度神经功能的患者。
