Hohenberger Christoph, Schmidt Corinna, Höhne Julius, Brawanski Alexander, Zeman Florian, Schebesch Karl-Michael
Department of Neurosurgery, University Regensburg Medical Center, University of Regensburg, Germany.
Department of Neurosurgery, University Regensburg Medical Center, University of Regensburg, Germany.
J Clin Neurosci. 2018 Jun;52:74-79. doi: 10.1016/j.jocn.2018.03.031. Epub 2018 Apr 2.
Space-occupying spinal metastases (SM), commonly diagnosed because of acute neurological deterioration, consequently lead to immediate decompression with tumor removal or debulking. In this study, we analyzed a series of patients with surgically treated spinal metastases and explicitly sought to determine individual predictors of functional outcome.
94 patients (26 women, 68 men; mean age 64.0 years) with spinal metastases, who had been surgically treated at our department, were included retrospectively. We reviewed the pre- and postoperative charts, surgical reports, radiographic data for demographics, duration of symptoms, histopathology, stage of systemic disease, co-morbidities, radiographic extension, surgical strategy, neurological performance (Frankel Grade Classification), and the Karnofsky Performance Index (KPI).
Emergency surgery within <24 h after discharge had been conducted in 33% of patients. Prostate carcinoma (29.5%) and breast carcinoma (11.6%) were the most common histopathologies. Median KPI was 60% at admission that had significantly improved at discharge (KPI 70%; p = 0.01). The rate of complications without revision was 4.3%, the revision rate 4.2%. From admission to discharge, pain had been significantly reduced (p = 0.019) and motor deficits significantly improved (p = 0.003). KPI had been significantly improved during in-hospital treatment (median 60 vs 70, p = 0.010). In the multivariable analysis, predictors of poor outcome (KPI < 70) were male sex, multiple metastases, and pre-existing bowel and bladder dysfunction. Median follow up was 2 months.
In our series, surgery for spinal metastases (laminectomy, tumor removal, and mass reduction) significantly reduced pain as well as sensory and motor deficits. We identified male sex, multiple metastases, and pre-existing bowel and bladder dysfunction as predictors of negative outcome.
占位性脊柱转移瘤（SM）通常因急性神经功能恶化而被诊断出来，因此需要立即进行减压并切除肿瘤或减轻肿瘤负荷。在本研究中，我们分析了一系列接受手术治疗的脊柱转移瘤患者，并明确试图确定功能预后的个体预测因素。
回顾性纳入了94例在我科接受手术治疗的脊柱转移瘤患者（26例女性，68例男性；平均年龄64.0岁）。我们查阅了术前和术后病历、手术报告、关于人口统计学、症状持续时间、组织病理学、全身疾病分期、合并症、影像学范围、手术策略、神经功能表现（Frankel分级）以及卡氏功能状态评分（KPI）的影像学数据。
33%的患者在出院后<24小时内接受了急诊手术。前列腺癌（29.5%）和乳腺癌（11.6%）是最常见的组织病理学类型。入院时KPI中位数为60%，出院时显著改善（KPI 70%；p = 0.01）。未进行翻修的并发症发生率为4.3%，翻修率为4.2%。从入院到出院，疼痛显著减轻（p = 0.019），运动功能障碍显著改善（p = 0.003）。住院治疗期间KPI显著改善（中位数60对70，p = 0.010）。在多变量分析中，预后不良（KPI < 70）的预测因素为男性、多发转移瘤以及既往存在的肠道和膀胱功能障碍。中位随访时间为2个月。
在我们的系列研究中，脊柱转移瘤手术（椎板切除术、肿瘤切除和减瘤）显著减轻了疼痛以及感觉和运动功能障碍。我们确定男性、多发转移瘤以及既往存在的肠道和膀胱功能障碍为不良预后的预测因素。
