Telera Stefano, Gorgoglione Nicola, Raus Laura, Vidiri Antonello, Villani Veronica, Pace Andrea, Fabi Alessandra, Crispo Francesco, Castiglione Melina, Sperduti Isabella, Boccaletti Riccardo
Department of Neurosurgery, IRCSS National Cancer Institute "Regina Elena", Rome, Italy.
Division of Neurosurgery, Messina University, Messina, Italy.
World Neurosurg. 2019 Jul;127:e751-e760. doi: 10.1016/j.wneu.2019.03.258. Epub 2019 Apr 2.
Symptomatic metastatic spine disease (MSD), is a challenging disease involving 3%-20% of patients with bone metastases. Different surgical options are available and must be tailored to the general and neurologic conditions of the patients. Open kyphoplasty (OKP) refers to decompressive hemilaminectomy, associated with a contralateral percutaneous kyphoplasty, and in some cases, to a posterior stabilization. The aim of the study was to critically review our experience during the last decade with OKP in patients with cancer.
Fifty-three patients with cancer underwent OKP for symptomatic MSD. The Tokuhashi score and Spinal Instability Neoplastic Score were calculated for each patient. Length of hospital stay, perioperative complications, incidence of adjacent-level fractures, and median survival after surgery were evaluated. Karnofsky Performance Status, visual analog scale, and Dennis Pain Score were calculated preoperatively, postoperatively, and at last follow-up.
Median Tokuhashi score and Spinal Instability Neoplastic Score were 10 and 10, respectively. The mean volume of filling material inserted was 3.6 mL. Median operative time was 180 minutes. Complications included 8 leakages (15%), 2 permanent motor deficits (3.8%), and 2 asymptomatic pulmonary embolisms (3.8%). Mean length of hospital stay was 7 days. A significant improvement was observed in Karnofsky Performance Status, visual analog scale score, and Dennis Pain Score (P < 0.0001). Median follow-up was 16 months and overall survival 22 months.
OKP was an effective treatment of symptomatic MSDs in selected oncologic patients with low Tokuhashi scores. It relieved lateral epidural compressions, expanded indications of palliative surgery in patients who were not otherwise surgical candidates, and rapidly dealt with cement leakages.
有症状的转移性脊柱疾病（MSD）是一种具有挑战性的疾病，在骨转移患者中占3% - 20%。有多种手术选择，必须根据患者的一般情况和神经状况进行调整。开放性椎体后凸成形术（OKP）是指减压性半椎板切除术，联合对侧经皮椎体后凸成形术，在某些情况下还包括后路固定。本研究的目的是严格回顾我们在过去十年中对癌症患者行OKP的经验。
53例癌症患者因有症状的MSD接受了OKP。为每位患者计算Tokuhashi评分和脊柱不稳定肿瘤评分。评估住院时间、围手术期并发症、相邻节段骨折发生率及术后中位生存期。在术前、术后及最后一次随访时计算卡氏功能状态评分、视觉模拟量表评分和丹尼斯疼痛评分。
Tokuhashi评分和脊柱不稳定肿瘤评分的中位数分别为10分和10分。填充材料的平均注入量为3.6 mL。中位手术时间为180分钟。并发症包括8例渗漏（15%）、2例永久性运动功能障碍（3.8%）和2例无症状肺栓塞（3.8%）。平均住院时间为7天。卡氏功能状态评分、视觉模拟量表评分和丹尼斯疼痛评分有显著改善（P < 0.0001）。中位随访时间为16个月，总生存期为22个月。
OKP是治疗Tokuhashi评分低的特定肿瘤患者有症状MSD的有效方法。它缓解了外侧硬膜外压迫，扩大了原本不适合手术患者的姑息性手术指征，并能迅速处理骨水泥渗漏。
