Department of Neurosurgery, John Hunter Hospital, New Lambton, Australia.
Resident Medical Officer, Prince of Wales Hospital, Randwick, Australia.
J Clin Neurosci. 2019 Oct;68:218-223. doi: 10.1016/j.jocn.2019.04.032. Epub 2019 Jul 19.
Metastatic disease to the vertebral column can cause spinal instability, neurological deterioration and pain. The present study was designed to provide insight into the cohort undergoing vertebrectomy for metastatic disease to the spinal column, assessing the associated morbidity, functional outcomes and survival. A retrospective review of 141 consecutive vertebrectomies for metastatic disease was undertaken. The procedures were performed between 2006 and 2016 at a single institution. Medical records were reviewed and data was obtained regarding primary malignancy, presenting symptoms, pre-operative chemotherapy or radiotherapy, Spinal Instability Neoplastic Score, neurological function, operative approach and duration, blood loss, transfusion requirement, complications, survival, delayed neurological deterioration and construct failure. Long-term follow-up data was available for 123 patients. Forty-two patients were alive at the time of review with a mean survival of 464 days. Post-operative neurological function was preserved or improved in 96.5% of patients. Five patients suffered a neurological deterioration post-operatively. The major complication rate was 19.8% with the most frequent complication being wound infection or dehiscence requiring revision. There were four inpatient deaths. Mean operative time was 240 min. Mean blood loss was 1490 mls. When assessing results by age, no significant difference with respect to complications, neurological outcomes or survival was demonstrated in patients over age 65. There was a significant reduction in survival and higher complication rates in patients who were non-ambulatory following vertebrectomy. Vertebrectomy is a safe and effective means of providing circumferential neural decompression and stabilization with an acceptable complication rate in patients with vertebral metastases, irrespective of age.
转移性脊柱疾病可导致脊柱不稳、神经功能恶化和疼痛。本研究旨在深入了解接受脊柱转移瘤切除术的患者人群，评估其相关发病率、功能结果和生存率。回顾性分析了 141 例连续接受脊柱转移瘤切除术的患者。该手术于 2006 年至 2016 年在一家医疗机构进行。查阅病历并获取以下数据：原发恶性肿瘤、首发症状、术前化疗或放疗、脊柱不稳肿瘤评分、神经功能、手术入路和时间、出血量、输血需求、并发症、生存率、迟发性神经功能恶化和结构失败。123 例患者有长期随访数据。在审查时，42 例患者存活，平均存活时间为 464 天。96.5%的患者术后神经功能保持或改善。5 例患者术后出现神经功能恶化。主要并发症发生率为 19.8%，最常见的并发症是伤口感染或裂开需要翻修。有 4 例住院死亡。平均手术时间为 240 分钟。平均失血量为 1490 毫升。按年龄评估结果时，65 岁以上患者在并发症、神经功能结果或生存率方面无显著差异。在接受脊柱转移瘤切除术的非步行患者中，生存率显著降低，并发症发生率更高。脊柱转移瘤切除术是一种安全有效的方法，可提供广泛的神经减压和稳定，并发症发生率可接受，无论年龄大小。
