GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Radiotherapy Unit, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Spine (Phila Pa 1976). 2020 Oct 1;45(19):1386-1394. doi: 10.1097/BRS.0000000000003623.
Case series.
For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics.
The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment.
An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics.
Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people.
Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy.
病例系列。
对于最常见的临床情况中的每一种，作者就如何优化时机和适应证以降低风险、同时保持新冠疫情下的预期结果达成了共识。
新冠疫情改变了医疗保健的组织方式，对脊柱肿瘤学手术产生了直接影响。急诊手术仍然是优先事项，但在脊柱肿瘤的情况下，最好明确哪些情况需要紧急治疗。
成立了一个由普通脊柱外科医生、骨肿瘤脊柱外科医生和放射肿瘤学家组成的专家小组，以分析新冠疫情期间脊柱肌肉骨骼肿瘤学中最常见的情况。
脊柱转移瘤可在随访期间偶然发现，也可因疼痛加重、病理性骨折和/或神经症状而出现临床症状。原发性脊柱肿瘤要少见得多，且很少呈急性发作。首先要怀疑这种罕见情况，避免将原发性肿瘤当作转移瘤来治疗。对于治疗低度恶性肿瘤（如脊索瘤或软骨肉瘤）的复杂手术，如整块切除术，由于重症监护病房可用性降低，如果不影响预后，可以将其最好延迟数周，因为这些肿瘤的生长速度较慢。目前接受的尤文肉瘤（ES）和骨肉瘤治疗方案必须用于局部和全身疾病控制。对于 ES，在化疗的第一个疗程后，可以选择在新冠疫情期间进行放疗，而不是手术，以完成整个化疗疗程。在免疫功能低下的患者（接受化疗治疗）中，需要避免接触受感染或暴露的人。
即使在正常时期，也需要多学科方法来共同决定修改治疗策略。
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