Sunnybrook Health Sciences Centre, Toronto, Canada.
Salford Royal Foundation Trust, Manchester, UK.
Clin Oncol (R Coll Radiol). 2020 Nov;32(11):745-752. doi: 10.1016/j.clon.2020.07.022. Epub 2020 Aug 19.
Malignant spinal cord compression is one of the most dreaded complications of advanced malignancy, with patients presenting with progressive paralysis, paresthesia and/or autonomic dysfunction. The choice of management should be guided by the expected prognosis and outcome, not just from a neurological function point-of-view but also from the metastatic cancer itself. The main indications for surgery are: impending cord compression, spinal instability from tumour progression, bony retropulsion, for tissue diagnosis and for pain resistant to conventional therapies. Here, surgical principles, traditional and novel techniques and complications will be reviewed. For radiotherapy, multiple randomised studies have shown that for most patients a single fraction of external radiation has the same functional outcomes compared with multi-fractionation protocols. The experience of a specialised centralised interdisciplinary team will also be discussed.
恶性脊髓压迫症是晚期恶性肿瘤最可怕的并发症之一，患者表现为进行性瘫痪、感觉异常和/或自主功能障碍。管理的选择应根据预期的预后和结果来指导，不仅要从神经功能的角度，还要从转移性癌症本身的角度。手术的主要适应证是：即将发生的脊髓压迫、肿瘤进展引起的脊柱不稳定、骨反冲、组织诊断和对常规治疗有抵抗的疼痛。在这里，将回顾手术原则、传统和新的技术以及并发症。对于放疗，多项随机研究表明，对于大多数患者，单次外照射与多次分割方案相比具有相同的功能结局。还将讨论专门的中央多学科团队的经验。
