1Department of Neurosurgery, MD Anderson Cancer Center; and.
2Department of Neurosurgery and.
Neurosurg Focus. 2021 May;50(5):E9. doi: 10.3171/2021.1.FOCUS20671.
Survival of cancer patients continues to improve with systemic treatment advancements, leading to an increase in cancer-related complications such as pathological spinal fractures. In this study, the authors aimed to evaluate the outcome of percutaneous stabilization with cement augmentation of the pedicle screws in the management of patients with metastatic cancer to the spine.
The authors reviewed a retrospective case series of 74 patients with symptomatic pathological spine fractures treated with cement-augmented pedicle screws implanted with a percutaneous technique. The mean imaging follow-up was 11.3 months. Data on demographics, clinical outcomes, and complications were collected. Cement extravasation, spinal hardware integrity, and fusion rates were assessed on CT scans.
Among 50 patients with follow-up imaging, 23 patients (46%) showed facet joint fusion. The length of segmental stabilization was not a significant predictor of the occurrence of fusion. Pre- or postoperative radiation therapy, postoperative chemotherapy, and the location of spinal lesions did not have a statistically significant effect on the occurrence of fusion. Patients older than 60 years of age were more likely to have fusion across facet joints compared with younger patients. There was a significant difference in the mean visual analog scale pain score, with 6.28 preoperatively and 3.41 postoperatively, regardless of fusion status (p < 0.001). Cement extravasation was seen in 51% of the cohort, but in all instances, patients remained asymptomatic. Most importantly, the incidence of hardware failure was low (4%).
Percutaneous fixation with cement-augmented pedicle screws in patients with pathological spine fractures provides an improvement in mechanical back pain, with a low incidence of failure, and in some patients, spontaneous facet fusion was observed. Further research is necessary with regard to both short-term benefits and long-term outcomes.
随着系统治疗的进步，癌症患者的生存率不断提高，导致与癌症相关的并发症（如病理性脊柱骨折）的发生率也有所增加。本研究旨在评估经皮骨水泥强化椎弓根螺钉固定治疗脊柱转移癌患者的疗效。
作者回顾性分析了 74 例采用经皮技术植入骨水泥强化椎弓根螺钉治疗症状性病理性脊柱骨折的患者的病例系列。平均影像学随访时间为 11.3 个月。收集了患者的人口统计学、临床结局和并发症等数据。通过 CT 扫描评估骨水泥渗漏、脊柱内固定物完整性和融合率。
在 50 例有随访影像学资料的患者中，23 例（46%）出现小关节融合。节段固定长度不是融合发生的显著预测因素。术前或术后放疗、术后化疗以及脊柱病变部位对融合的发生均无统计学意义。年龄大于 60 岁的患者与年龄较小的患者相比，更容易出现小关节融合。无论融合状态如何，患者的平均视觉模拟评分均有显著差异，术前为 6.28，术后为 3.41（p<0.001）。该队列中有 51%的患者出现骨水泥渗漏，但所有患者均无症状。最重要的是，内固定失败的发生率较低（4%）。
经皮骨水泥强化椎弓根螺钉固定治疗病理性脊柱骨折可改善机械性腰背疼痛，失败率低，在某些患者中可观察到自发的小关节融合。需要进一步研究其短期获益和长期结局。
