Colangeli S, Capanna R, Bandiera S, Ghermandi R, Girolami M, Parchi P D, Pipola V, Sacchetti F, Gasbarrini A
Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy.
Eur Rev Med Pharmacol Sci. 2020 Jun;24(12):6526-6532. doi: 10.26355/eurrev_202006_21636.
Up to 70% of patients with cancer are likely to develop spine metastasis. Radiation therapy is the standard of care for painful spinal metastases in absence of unstable or impending fractures. More frequently these patients require open palliative surgery for pain, vertebral collapse and neurological deficits. Minimally Invasive Spine Surgery (MISS) techniques using percutaneous pedicle screw fixation may be considered as an alternative to open surgery in selected cases. MISS techniques are thought to be associated with fewer tissues damages resulting in early pain relief, they also allow for early mobilization and optimization of function.
From 2011 to 2018, 52 patients affected by spinal metastasis were treated with MISS techniques in Rizzoli Orthopaedic Institute of Bologna and in Cisanello Hospital of Pisa, Italy. All patients underwent percutaneous pedicle screw fixations (PPSF) coupled with mini-decompressions in case it was required by spinal cord compressions. All patients were evaluated pre and post-operatively by Frenkel classification and VAS scores.
Mean follow-up time was 19,4 months. Preoperatively, Frankel scores were E in 37 patients, D3 in 6 patients, D2 in 3 cases, D1 in 3 patients, B in one patient and C in two. The Frankel score improved in 10 patients, remained stable in 40 patients and worsened in two patients. Preoperatively, the mean VAS score in 29 patients treated with PPSF procedure with spinal decompression was 7, while postoperatively, it became 5. In 23 patients who underwent only PPSF procedure without spinal decompression mean VAS score was 5, postoperatively it became 3.
In selected cases, MISS surgeries may be considered as a valid alternative to open surgery. Although the efficacy of PPSF has been well documented in trauma or degenerative spine surgery, there is not sufficient literature about MISS techniques in spinal metastasis and further studies are needed to elucidate the most appropriate patient in which this approach could represent the gold standard of treatment.
高达70%的癌症患者可能发生脊柱转移。在不存在不稳定或即将发生骨折的情况下，放射治疗是疼痛性脊柱转移的标准治疗方法。这些患者更常需要进行开放性姑息手术来缓解疼痛、治疗椎体塌陷和神经功能缺损。在某些特定情况下，使用经皮椎弓根螺钉固定的微创脊柱手术（MISS）技术可被视为开放性手术的替代方案。MISS技术被认为与较少的组织损伤相关，从而能实现早期疼痛缓解，还能使患者早期活动并优化功能。
2011年至2018年期间，意大利博洛尼亚的里佐利骨科研究所和比萨的奇萨内洛医院对52例脊柱转移患者采用了MISS技术进行治疗。所有患者均接受了经皮椎弓根螺钉固定（PPSF），若因脊髓受压需要，则同时进行微型减压。所有患者术前和术后均通过弗伦克尔分类和视觉模拟评分（VAS）进行评估。
平均随访时间为19.4个月。术前，37例患者弗伦克尔评分为E级，6例为D3级，3例为D2级，3例为D1级，1例为B级及2例为C级。10例患者的弗伦克尔评分有所改善，40例保持稳定，2例恶化。术前，29例行PPSF联合脊柱减压手术患者的平均VAS评分为7分，术后变为5分。23例仅行PPSF手术而未行脊柱减压的患者，术前平均VAS评分为5分，术后变为3分。
在某些特定情况下，MISS手术可被视为开放性手术的有效替代方案。尽管PPSF在创伤或退行性脊柱手术中的疗效已有充分记录，但关于MISS技术在脊柱转移中的文献并不充分，需要进一步研究以阐明最适合采用这种方法作为治疗金标准的患者。
