Department of Neurological Surgery, Medical University of South Carolina, Charleston, SC, 301 CSB, USA.
Department of Neurooncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
Eur Spine J. 2021 Oct;30(10):2906-2914. doi: 10.1007/s00586-021-06880-7. Epub 2021 May 30.
Metastatic epidural spinal cord compression (MESCC) is a debilitating sequela of cancer that results in pain, disability, and neurologic deficits. Surgical techniques have included open surgical (OS) techniques with anterior and/or posterior decompression and fusion procedures. Further technical evolution has led to minimally invasive spinal (MIS) decompression and fusion. The objective of this study is to compare MIS to OS techniques in the treatment of thoracolumbar MESCC.
A review of the literature was performed using PubMed database. Inclusion criteria included patients 18 years or older, thoracolumbar MESCC, and surgeries with instrumented fusion. A total of 451 articles met the inclusion criteria and further analysis narrowed them down to 81 articles. Variables collected included blood loss, length of stay, operative time, pre- and postoperative Frankel grade, and complications.
A total of 5726 papers were collected, with a total of 81 papers meeting final inclusion criteria: 26 papers with MIS technique and 55 with OS. A total of 2267 patients were evaluated. They were split into three surgical subtypes of MIS and OS: posterior decompression and fusion, partial corpectomy, and complete corpectomy. Overall, MIS had lower operative time, blood loss, and complications compared to OS. A timeline analysis showed reduction of complication rates in MIS surgery between papers published over a 28-year period.
MESCC carries significant morbidity and mortality. Surgical approaches for palliative treatment should account for this fact. We conclude that MIS techniques offer a viable alternative to traditional OS approaches with lower overall morbidity and complications.
转移性硬膜外脊髓压迫症（MESCC）是癌症的一种使人衰弱的后遗症，可导致疼痛、残疾和神经功能缺损。手术技术包括前路和/或后路减压融合的开放性手术（OS）技术。进一步的技术发展导致了微创脊柱（MIS）减压和融合。本研究的目的是比较 MIS 与 OS 技术在胸腰椎 MESCC 的治疗中的作用。
使用 PubMed 数据库进行文献回顾。纳入标准包括年龄在 18 岁或以上、胸腰椎 MESCC 以及有器械融合的手术。共有 451 篇文章符合纳入标准，进一步分析将其缩小到 81 篇文章。收集的变量包括出血量、住院时间、手术时间、术前和术后 Frankel 分级以及并发症。
共收集了 5726 篇论文，其中共有 81 篇符合最终纳入标准：26 篇采用 MIS 技术，55 篇采用 OS。共评估了 2267 例患者。他们分为三种 MIS 和 OS 手术亚型：后路减压融合、部分椎体切除术和全椎体切除术。总体而言，MIS 手术的手术时间、出血量和并发症均低于 OS。时间线分析显示，在 28 年的时间里，MIS 手术的并发症发生率有所下降。
MESCC 具有显著的发病率和死亡率。姑息性治疗的手术方法应该考虑到这一事实。我们的结论是，MIS 技术为传统的 OS 方法提供了一种可行的替代方法，具有较低的总体发病率和并发症。
