Hashmi Syed Muhammad Maroof, Hammoud Ibrahim, Kumar Pranaw, Sartaj Afaq Ali, Ghosh Kaushik, Ray Arupratan, Golash Aprajay
Department of Neurosurgery, Royal Preston Hospital, Lancashire, United Kingdom.
Asian J Neurosurg. 2022 Dec 10;17(4):577-583. doi: 10.1055/s-0042-1758846. eCollection 2022 Dec.
The spinal column is one of the most prevalent regions for metastasis, with an increasing frequency of spinal metastases. Spinal cord metastatic tumor damages the vertebral body, weakens the spinal support, and exerts mass effect on the spinal cord. Overzealous surgical intervention does not provide any additional benefit in most of the spinal metastasis due to shorter life expectancy. The principal goal of this study is to analyze the outcome of various surgical treatments offered to patients with metastatic spinal cord compression (MSCC). Retrospective cohort study including all patients that underwent surgical intervention for MSCC from March 2013 to March 2020. A total of 198 patients were included, 113 males and 85 females; the mean age was 62 years. The most common primary cancer was prostate (21.71%) followed by hematological (20.07%) and lung (16.66%). At 6-month postsurgery, 68.68% of patients were Frankel grade D or E (vs. 23.23% preoperatively), 16.6% were grade C (vs 57% preoperatively), and 14.64% were grade A or B (vs. 19.69% preoperatively). Pain on numeric rating scale was decreased from 6.38 ± 3.08 to 3.39 ± 0.73 at 24 hours postsurgery and 1.94 ± 0.67 at 6 months. This study found that the majority of patients, undergoing minimally invasive spinal stabilization and decompression for metastatic spinal tumors, have better quality of life, analgesia, and mobility. In conclusion, treatment for spinal metastases should be individualized and a multidisciplinary approach is needed.
脊柱是转移瘤最常见的部位之一,脊柱转移的发生率呈上升趋势。脊髓转移瘤会破坏椎体,削弱脊柱支撑力,并对脊髓产生占位效应。由于患者预期寿命较短,在大多数脊柱转移瘤病例中,过度积极的手术干预并不会带来额外益处。本研究的主要目的是分析为转移性脊髓压迫(MSCC)患者提供的各种手术治疗的结果。
回顾性队列研究,纳入2013年3月至2020年3月期间接受MSCC手术干预的所有患者。
共纳入198例患者,其中男性113例,女性85例;平均年龄为62岁。最常见的原发癌是前列腺癌(21.71%),其次是血液系统肿瘤(20.07%)和肺癌(16.66%)。术后6个月时,68.68%的患者Frankel分级为D级或E级(术前为23.23%),16.6%为C级(术前为57%),14.64%为A级或B级(术前为19.69%)。数字评分量表上的疼痛评分在术后24小时从6.38±3.08降至3.39±0.73,在6个月时降至1.94±0.67。
本研究发现,大多数接受微创脊柱稳定和减压治疗转移性脊柱肿瘤的患者生活质量、镇痛效果和活动能力更佳。总之,脊柱转移瘤的治疗应个体化,需要多学科方法。