Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Eur Spine J. 2021 Oct;30(10):2791-2799. doi: 10.1007/s00586-020-06647-6. Epub 2020 Nov 12.
The goal of this study was to review the incidence of complications and unplanned re-operations after surgery for metastatic spinal tumors.
The spinal column is the most common osseous site for metastatic spread. The goals of the treatment of spinal metastases are largely palliative. The surgical aims include establishing a diagnosis, providing stability, relieving neurological compression and deterioration, decreasing pain and increasing patient independence. Patients with spinal metastases who undergo surgery are considered high risk, with higher morbidity and mortality rates.
A systematic review was undertaken; PubMed and Embase databases were searched between (2010-2020) for relevant publications in English language with the following search items: metastasis OR metastases AND spine AND surgery AND complications OR revision. Using a standard PRISMA template, 2293 articles were identified. Full-text articles of interest were assessed for inclusion criteria of greater than 30 patients.
A final number of 19 articles fully met the search criteria. Four were level II evidence, and the remaining were level III/IV. Surgical site infection 6.5% (135/2088) was reported as the main complication following surgery for spinal metastases followed by neurological deterioration 3.3% (53/1595) and instrumentation failure 2.0% (30/1501). Re-operation rate was 8.3% (54/651), with SSI (27.8%) being the most common reason for revision surgery.
Patients with spinal metastases frequently present with complex therapeutic challenges requiring multidisciplinary team assessment. Surgical site infection (6.5%) was the main reason for a re-operation in patients undergoing surgery for spinal metastases.
本研究旨在回顾转移性脊柱肿瘤手术后并发症和非计划性再次手术的发生率。
脊柱是骨转移最常见的部位。脊柱转移治疗的主要目标是姑息性的。手术的目的包括明确诊断、提供稳定性、缓解神经压迫和恶化、减轻疼痛和提高患者的独立性。接受手术的脊柱转移患者被认为是高风险的，其发病率和死亡率更高。
进行了系统评价；在 PubMed 和 Embase 数据库中检索了 2010 年至 2020 年间发表的英文文献，检索词为转移瘤或转移、脊柱、手术、并发症或修正。使用标准的 PRISMA 模板，确定了 2293 篇文章。对感兴趣的全文文章进行评估，以确定纳入标准为大于 30 例患者。
最终有 19 篇文章完全符合检索标准。其中 4 篇为 2 级证据，其余为 3 级/4 级证据。手术治疗脊柱转移后，主要并发症为手术部位感染 6.5%（135/2088），其次为神经功能恶化 3.3%（53/1595）和器械失败 2.0%（30/1501）。再次手术率为 8.3%（54/651），其中手术部位感染（27.8%）是再次手术的最常见原因。
脊柱转移患者常出现复杂的治疗挑战，需要多学科团队评估。手术部位感染（6.5%）是脊柱转移患者接受手术治疗后再次手术的主要原因。
