The Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
The Department of Orthopaedic Surgery, Changsu No.2. People's Hospital, Suzhou, China.
Orthop Surg. 2022 Aug;14(8):1827-1835. doi: 10.1111/os.13316. Epub 2022 Jul 6.
To compare the safety and efficacy of posterior internal fixation with open vertebroplasty (VP) and posterior internal fixation with open kyphoplasty (KP) in the treatment of metastatic epidural spinal cord compression (MESCC) with posterior wall destruction.
This retrospective study, conducted between January 2016 and May 2019, equally divided 60 patients with MESCC and posterior wall destruction into two groups based on the surgical method: open vertebroplasty with pedicle screw fixation (VP group) and open kyphoplasty with pedicle screw fixation (KP group). Visual analogue scale (VAS), SF-36 scores, middle vertebral height (MVH), and posterior vertebral height (PVH) were evaluated for the two groups preoperatively, postoperatively, and 1 year after surgery. Spinal Instability Neoplastic Score, Frankel grades and complications were recorded and evaluated.
Five patients were excluded from the analysis, and our study cohort consisted of 55 adult patients who met the inclusion criteria. The VAS and SF-36 scores of these two groups of patients significantly improved, when compared with those before the surgery (P < 0.05). There were significant differences in total cost (8835 ± 1468 vs 9540 ± 053 USD) and cement volume (4.51 ± 0.96 ml vs 6.35 ± 1.09 ml) between two groups (P < 0.05). The MVH and PVH of these two groups of patients significantly improved, when compared with those before the surgery (P < 0.05). The MVH was significantly larger in the KP group than in the VP group postoperatively (20.15 ± 4.86 vs 17.70 ± 3.78, P < 0.05) and at the final follow-up (20.42 ± 5.59 vs 17.28 ± 3.23, P < 0.05). However, the PVH of the two groups did not significantly differ at the two postoperative follow-ups (P > 0.05). No significant differences were found in surgery time, time from surgery to discharge, blood loss and complications between both groups postoperatively (P > 0.05).
In the short term, both approaches are effective and safe in patients with MESCC and posterior wall destruction. The posterior internal fixation with open VP may be a good choice of surgical method in patients with MESCC and posterior wall defects.
比较后路内固定联合开放椎体成形术（VP）与后路内固定联合开放后凸成形术（KP）治疗伴有后壁破坏的转移性硬膜外脊髓压迫症（MESCC）的安全性和疗效。
本回顾性研究于 2016 年 1 月至 2019 年 5 月进行，根据手术方法将 60 例伴有后壁破坏的 MESCC 患者分为两组：后路内固定联合开放椎体成形术（VP 组）和后路内固定联合开放后凸成形术（KP 组）。术前、术后及术后 1 年对两组患者的视觉模拟评分（VAS）、SF-36 评分、椎体中间高度（MVH）和椎体后高度（PVH）进行评估。记录并评估脊柱不稳定肿瘤评分（Spinal Instability Neoplastic Score，SINS）、Frankel 分级和并发症。
排除 5 例患者后，本研究共纳入 55 例符合纳入标准的成年患者。两组患者的 VAS 和 SF-36 评分均较术前显著改善（P<0.05）。两组总费用（8835±1468 美元比 9540±053 美元）和水泥体积（4.51±0.96ml 比 6.35±1.09ml）存在显著差异（P<0.05）。两组患者的 MVH 和 PVH 均较术前显著改善（P<0.05）。术后 KP 组的 MVH 明显大于 VP 组（20.15±4.86 比 17.70±3.78，P<0.05），术后随访终末时亦大于 VP 组（20.42±5.59 比 17.28±3.23，P<0.05）。然而，两组在术后两次随访时的 PVH 均无显著差异（P>0.05）。两组术后手术时间、从手术到出院时间、出血量和并发症均无显著差异（P>0.05）。
短期内，后路内固定联合开放 VP 和 KP 治疗伴有后壁破坏的 MESCC 患者均安全有效。对于伴有后壁缺损的 MESCC 患者，后路内固定联合开放 VP 可能是一种较好的手术方法选择。
