Serikyaku Hisashi, Higa Shoichiro, Yara Tetsuya, Oshiro Takuma
Department of Orthopedic Surgery, Naha City Hospital, Okinawa, Japan.
Department of Orthopedic Surgery, Naha City Hospital, Okinawa, Japan.
Int J Surg Case Rep. 2022 Apr;93:106848. doi: 10.1016/j.ijscr.2022.106848. Epub 2022 Mar 1.
To summarize the clinical manifestations and treatment of a patient with lumbar metastases from renal cell carcinoma who underwent unilateral fixation of lumbosacral spine utilizing minimally invasive surgery systems.
A 71-year-old woman presented to a local hospital with complaints of low back pain. Computed tomography (CT) at the hospital revealed metastases to the lung, occipital bone, right ribs and fifth lumbar vertebrae from a primary left renal cancer. A lumbar Magnetic resonance imaging (MRI) performed at local clinic revealed an enlarged metastatic tumor invading the right body, transverse process and pedicle of fifth lumbar vertebra. Transmyofascial insertion of pedicle screws and connection with rod utilizing minimally invasive surgery (MIS) systems were made on the left L4.5.S1 vertebrae under fluoroscopy. The operating time was 36 min, the intraoperative blood loss was 30 g and fluoroscopic time was 56 s. Postoperative course was uneventful. She could walk with a single cane on the twenty postoperative days but passed away of systemic metastasis approximately10 months after the spinal fixation. An x-ray taken just before death showed no spinal instrumentation failure.
Surgery for spinal metastasis from hypervascular tumor may result in profuse intraoperative bleeding that is difficult to control. It might be preferable to operate with MIS if patients with spinal metastases are candidate for either MIS or conventional methods. It has been reported that unilateral fixation could be as effective as bilateral fixation in up to two-segment lumbar spinal fusion.
Unilateral fixation utilizing MIS systems may be effective in cases whom placing an instrumentation on the side with tumor extending posteriorly may cause massive bleeding.
总结一名肾细胞癌腰椎转移患者的临床表现及治疗情况，该患者采用微创手术系统对腰骶椎进行单侧固定。
一名71岁女性因腰痛就诊于当地医院。医院的计算机断层扫描（CT）显示，原发性左肾癌已转移至肺部、枕骨、右肋骨和第五腰椎。当地诊所进行的腰椎磁共振成像（MRI）显示，一个增大的转移瘤侵犯了第五腰椎的右侧椎体、横突和椎弓根。在荧光透视下，采用微创手术（MIS）系统经肌筋膜在左侧L4、5、S1椎体置入椎弓根螺钉并连接棒。手术时间为36分钟，术中失血30克，透视时间为56秒。术后过程顺利。术后20天她可以单拐行走，但在脊柱固定后约10个月因全身转移去世。临终前拍摄的X线片显示脊柱内固定无失败。
高血运肿瘤脊柱转移手术可能导致术中大量出血且难以控制。如果脊柱转移患者适合微创手术或传统手术方法，采用微创手术可能更可取。据报道，在多达两节段的腰椎融合术中，单侧固定与双侧固定效果相当。
对于肿瘤向后延伸一侧置入内固定可能导致大量出血的病例，采用微创手术系统进行单侧固定可能有效。
