Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Division of Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
J Clin Neurosci. 2022 Jan;95:88-93. doi: 10.1016/j.jocn.2021.11.036. Epub 2021 Dec 9.
Optimal management of metastatic lung cancer to the spine (MLCS) incorporates a multidisciplinary approach. With improvements in lung cancer screening andnonsurgical treatment, the role for surgerymay be affected. The objective of this study is to assess trends in the surgical management of MLCS using the National Inpatient Sample (NIS) database. The NIS was queried for patients with MLCS who underwent surgery from 2005 to 2014. The frequencies of spinal decompression alone, spinal stabilization with or without (+/-) decompression, and vertebral augmentation were calculated. Statistical analysis was performed to analyze the effect of patient characteristics on outcomes. The most common procedure performed was vertebral augmentation (10719, 44.3%), followed by spinal stabilization +/- decompression (8634, 35.7%) and then decompression alone (4824, 20.0%). The total number of surgeries remained stable, while the rate of spinal stabilizations increased throughout the study period (p < 0.001). Invasive procedures such as stabilization and decompression were associated with greater costs, length of stay,complications and mortality. Increasingcomorbidity was associated with increased odds of complication, especially in patients undergoing more invasive procedures. In patients with lowpre-operative comorbidity, the type of procedure did not influence the odds of complication. Graded increases in length of stay, cost and mortality were seen with increasing complication rate.The rate of spinal stabilizations increased, which may be due to either increased early detection of disease facilitating use of outpatient vertebral augmentation procedures and/or the recognition that surgical decompression and stabilization are necessary for optimal outcome in the setting of MLCS with neurological deficit.
转移性肺癌脊柱病变（MLCS）的最佳治疗方法包括多学科综合治疗。随着肺癌筛查和非手术治疗的进步，手术的作用可能会受到影响。本研究的目的是使用国家住院患者样本（NIS）数据库评估 MLCS 手术治疗的趋势。从 2005 年到 2014 年，对 NIS 数据库中接受手术治疗的 MLCS 患者进行了检索。计算了单纯脊柱减压、脊柱稳定术（有/无减压）和椎体强化术的频率。统计学分析用于分析患者特征对结果的影响。最常见的手术是椎体强化术（10719 例，44.3%），其次是脊柱稳定术 +/-减压（8634 例，35.7%）和单纯减压术（4824 例，20.0%）。手术总数保持稳定，而脊柱稳定术的比例在整个研究期间呈上升趋势（p<0.001）。稳定和减压等侵袭性手术与更高的成本、住院时间、并发症和死亡率相关。合并症的增加与并发症的几率增加相关，尤其是在接受更具侵袭性手术的患者中。在术前合并症较少的患者中，手术类型并不影响并发症的几率。随着并发症发生率的增加，住院时间、成本和死亡率呈递增趋势。脊柱稳定术的比例增加，这可能是由于疾病的早期发现增加，促进了门诊椎体强化术的应用，或者认识到在有神经功能缺损的 MLCS 患者中，手术减压和稳定是获得最佳结果所必需的。
