1Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, and.
2Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Neurosurg Focus. 2021 May;50(5):E8. doi: 10.3171/2021.2.FOCUS201087.
Cancer is one of the leading causes of death and greatly decreases a patient's quality of life. Vertebral metastases often lead to epidural spinal cord compression (ESCC) requiring surgical therapy. It has previously been shown that in patients with metastatic ESCC (MESCC), a surgical intervention leads to an improved outcome. Although the treatment paradigms in spinal metastases have changed and separation surgery followed by stereotactic radiosurgery is considered the best strategy, there are still cases in which 360° decompression with stabilization is indicated. In these patients, a proper bone fusion should be the treatment goal to guarantee good clinical results in extended survival times through progressions in oncological therapies. The aim of this study was to examine the safety and feasibility of posterior vertebral column resection (pVCR) in everyday clinical practice, achievement of bone fusion, and midterm outcome in patients with MESCC.
All patients treated with pVCR due to MESCC between 2013 and 2020 were enrolled in this observational single-center study. Demographics, outcome parameters, numeric rating scale (NRS) score, Frankel grade, and Karnofsky Performance Scale (KPS) score were evaluated. Radiological images routinely acquired during follow-up were reviewed and screened for the presence of bone fusion.
Sixty-six patients were treated by eight surgeons. The mean follow-up period was 549 ± 739 days. At baseline, the average age was 64.4 ± 10.9 years. Reported NRS scores (preoperative 6.2 ± 1.7 vs postoperative 3.4 ± 1.6) and segmental kyphosis as measured on sagittal CT images (preoperative 13.5° ± 8.6° vs postoperative 3.8° ± 5.4°) decreased significantly (p < 0.001). In only 2 patients (3%), the Frankel grade worsened postoperatively, whereas in 12 patients (18.2%) an improvement was documented. The KPS score remained constant during the observation period (preoperative 73.2% ± 18.2% vs 78.3% ± 18% at last follow-up). Bone fusion was observed in 26 patients (86.7%) receiving CT more than 100 days after the index surgery.
pVCR is a reliable surgical technique in daily clinical practice, which proves to be beneficial in terms of short- as well as midterm outcome, as judged by the KPS and NRS. The overall improvement in the Frankel grade shows patient safety. A bone fusion was observed regularly in oncological patients undergoing pVCR. The authors therefore conclude that pVCR is a safe, fast, and efficient strategy to achieve stability and pain relief by achievement of bone fusion in cancer patients.
癌症是导致死亡的主要原因之一，极大地降低了患者的生活质量。脊柱转移常导致硬膜外脊髓压迫（ESCC），需要手术治疗。先前的研究表明，在转移性 ESCC（MESCC）患者中，手术干预可改善预后。尽管脊柱转移的治疗模式已经发生变化，分离手术加立体定向放射外科被认为是最佳策略，但仍有一些情况下需要进行 360°减压和稳定。在这些患者中，适当的骨融合应该是治疗目标，以通过肿瘤治疗的进展保证良好的临床结果和延长生存时间。本研究的目的是在日常临床实践中检查后路脊柱全长切除术（pVCR）的安全性和可行性，以及 MESCC 患者的骨融合和中期结果。
本研究为回顾性单中心研究，纳入了 2013 年至 2020 年期间因 MESCC 接受 pVCR 治疗的所有患者。评估了人口统计学资料、结局参数、数字评分量表（NRS）评分、Frankel 分级和卡诺夫斯基绩效量表（KPS）评分。对常规随访时获得的影像学图像进行了回顾和筛选，以确定骨融合情况。
共 8 名外科医生对 66 例患者进行了治疗。平均随访时间为 549±739 天。基线时，平均年龄为 64.4±10.9 岁。报告的 NRS 评分（术前 6.2±1.7 与术后 3.4±1.6）和矢状位 CT 图像上测量的节段性后凸（术前 13.5°±8.6°与术后 3.8°±5.4°）显著降低（p<0.001）。只有 2 例（3%）患者术后 Frankel 分级恶化，而 12 例（18.2%）患者的分级得到改善。KPS 评分在观察期间保持不变（术前 73.2%±18.2%与末次随访时的 78.3%±18%）。在接受 CT 检查 100 天以上的 26 例（86.7%）患者中观察到骨融合。
后路脊柱全长切除术（pVCR）在日常临床实践中是一种可靠的手术技术，从 KPS 和 NRS 评分来看，该手术在短期和中期结果方面都具有优势。Frankel 分级的整体改善表明了患者的安全性。接受 pVCR 的肿瘤患者经常观察到骨融合。因此，作者得出结论，后路脊柱全长切除术（pVCR）是一种安全、快速、有效的策略，可以通过实现骨融合来达到稳定性和缓解疼痛，从而改善癌症患者的预后。
