Nater Anick, Sahgal Arjun, Fehlings Michael
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Department of Radiation Oncology, Sunnybrook Odette Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Handb Clin Neurol. 2018;149:239-255. doi: 10.1016/B978-0-12-811161-1.00016-5.
Due to a worldwide increase of cancer incidence and a longer life expectancy of patients with metastatic cancer, a rise in the incidence of symptomatic vertebral metastases has been observed. Metastatic spinal disease is one of the most dreaded complications of cancer as it is not only associated with severe pain, but also with paralysis, sensory loss, sexual dysfunction, urinary and fecal incontinency when the neurologic elements are compressed. Rapid diagnosis and treatment have been shown to improve both the quality and length of remaining life. This chapter on vertebral metastases with epidural disease and intramedullary spinal metastases will be discussed in terms of epidemiology, pathophysiology, demographics, clinical presentation, diagnosis, and management. With respect to treatment options, our review will summarize the evolution of conventional palliative radiation to modern stereotactic body radiotherapy for spinal metastases and the surgical evolution from traditional open procedures to minimally invasive spine surgery. Lastly, we will review the most common clinical prediction and decision rules, framework and algorithms, and guidelines that have been developed to guide treatment decision making.
由于全球癌症发病率上升以及转移性癌症患者预期寿命延长，有症状的椎体转移瘤发病率呈上升趋势。转移性脊柱疾病是癌症最可怕的并发症之一，因为它不仅与严重疼痛相关，而且当神经结构受压时还会导致瘫痪、感觉丧失、性功能障碍、大小便失禁。快速诊断和治疗已被证明可改善剩余生命的质量和长度。本章将从流行病学、病理生理学、人口统计学、临床表现、诊断和管理等方面讨论伴有硬膜外疾病和脊髓内转移的椎体转移瘤。关于治疗选择，我们的综述将总结传统姑息性放疗到现代立体定向体部放疗治疗脊柱转移瘤的演变，以及从传统开放手术到微创脊柱手术的外科手术演变。最后，我们将回顾为指导治疗决策而制定的最常见临床预测和决策规则、框架和算法以及指南。
