Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan.
Medicina (Kaunas). 2022 Mar 1;58(3):358. doi: 10.3390/medicina58030358.
: There have been numerous advances in spine surgery for metastatic spinal tumors, and minimally invasive spine stabilization (MISt) is becoming increasingly popular in Japan. MISt is a minimally invasive fixation procedure that temporarily stabilizes the spine, thereby reducing pain, preventing pathological fractures, and improving activities of daily living at an early stage. MISt may be useful given the recent shift toward outpatient cancer treatment. : This study enrolled 51 patients with metastatic spinal tumors who underwent surgery using MISt between December 2013 and October 2020. The Spinal Instability Neoplastic Score, an assessment of spinal instability, was used to determine the indication for surgery, and the Epidural Spinal Cord Compression scale was used for additional decompression. : The patients comprised 34 men and 17 women, and the mean age at surgery was 68.9 years. The mean postoperative follow-up period was 20.8 months, and 35 of 51 patients (67%) had died by the last survey. The mean operative time was 159.8 min, mean blood loss was 115.7 mL, and mean time to ambulation was 3.2 days. No perioperative complications were observed, although two patients required refixation surgery. Preoperatively, 37 patients (72.5%) were classified as Frankel grade E. There were no cases of postoperative exacerbation, and six patients showed improvement of one or more Frankel grades after surgery. The median duration of patient survival was about 22.0 months. Patients with breast, prostate, renal, and thyroid cancers had a good prognosis, whereas those with gastrointestinal and head and neck cancers had a poor prognosis. : MISt can benefit patients who are ineligible for conventional, highly invasive surgery and is also suitable because cancer treatment is increasingly performed on an outpatient basis. Furthermore, choosing the right surgery for the right patient at the right time can significantly affect life expectancy.
: 脊柱转移瘤的脊柱外科治疗取得了许多进展，微创脊柱稳定术（MISt）在日本越来越受欢迎。MISt 是一种微创固定术，可暂时稳定脊柱，从而减轻疼痛、预防病理性骨折，并在早期提高日常生活能力。鉴于最近向门诊癌症治疗的转变，MISt 可能会很有用。 : 本研究纳入了 2013 年 12 月至 2020 年 10 月期间接受 MISt 手术的 51 例脊柱转移瘤患者。脊柱不稳定肿瘤评分用于评估脊柱稳定性，以确定手术适应证，硬膜外脊髓压迫评分用于进一步减压。 : 患者包括 34 名男性和 17 名女性，手术时的平均年龄为 68.9 岁。平均术后随访时间为 20.8 个月，截至最后一次调查时，51 例患者中有 35 例（67%）死亡。手术平均时间为 159.8 分钟，平均失血量为 115.7 毫升，平均下床活动时间为 3.2 天。虽然有 2 例患者需要再次固定，但未发生围手术期并发症。术前，37 例（72.5%）患者为 Frankel 分级 E 级。无术后恶化病例，术后 6 例 Frankel 分级提高一级或以上。患者的中位生存时间约为 22.0 个月。乳腺癌、前列腺癌、肾癌和甲状腺癌患者预后较好，而胃肠道癌和头颈部癌患者预后较差。 : MISt 可使不适合传统高度侵袭性手术的患者受益，并且由于癌症治疗越来越多地在门诊进行，因此 MISt 也适合此类患者。此外，在适当的时间为适当的患者选择正确的手术可以显著影响预期寿命。
