Feng Qi, Zhang Zibo, Wang Donglai, Feng Jiangang
Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Transl Cancer Res. 2022 Dec;11(12):4397-4408. doi: 10.21037/tcr-22-2631.
The incidence of cancer patients with bone metastasis is increasing annually. With the advancement of medical treatment for malignant tumors, the survival time of patients with spinal metastases is gradually being prolonged, and adjacent segment vertebral metastases often occur after conventional pedicle screw (CPS) surgery, leading to spinal instability, pain and nerve function injury again, with repeated symptoms. Combined pedicle screw fixation can maintain or reconstruct the spinal stability. This study aimed to investigate the efficacy and safety of cement-augmented fenestrated pedicle screws in the posterior approach for spinal metastases by comparing with CPS.
From January 2017 to August 2019, 52 patients with spinal metastases who underwent separation surgery and internal fixation via posterior approach were retrospectively enrolled. Cases were divided into the cement-augmented pedicle screw (CAPS) group (28 cases) and the CPS group (24 cases). The baseline data [age, gender, surgical sites, surgical segment, Tomita classification, Tomita score, Tokuhashi score, spinal instability neoplastic score (SINS)], surgical information, and local progression-free survival (PFS) time were compared between the two groups. Every patient was followed-up every 3 months with imaging examination. The visual analog scale (VAS) score and Frankel grade of the two groups were recorded before and 3 months after the operation were used to evaluate the efficacy. The operation time, the amount of intraoperative blood loss, the amount of bone cement injected in the pedicle screw group, and the complications of the surgery were recorded to evaluate the safety of CAPS.
The baseline characteristics were comparable between the two group. Compared with the CPS group, the CAPS group showed significantly longer operation time (163±20 138±18 min, P<0.001) and lower VAS scores (2.93±1.33 4.17±1.34, P=0.002). Adjacent segment vertebral metastasis occurred in 10 cases (2 in the CAPS group and 8 in the CPS group, P=0.017). Internal implant failure occurred in 8 cases (1 in the CAPS group and 7 in the CPS group, P=0.011). Compared with the CPS group, the CAPS group had a significantly longer local PFS time (P<0.05).
CAPS could be a safe and effective choice in surgery for spinal metastases with the posterior approach.
骨转移癌患者的发病率逐年上升。随着恶性肿瘤医疗水平的提高，脊柱转移瘤患者的生存时间逐渐延长，传统椎弓根螺钉（CPS）手术后常发生相邻节段椎体转移，导致脊柱不稳、疼痛及神经功能再次受损，症状反复。联合椎弓根螺钉内固定可维持或重建脊柱稳定性。本研究旨在通过与CPS对比，探讨后路椎体成形术联合开窗椎弓根螺钉治疗脊柱转移瘤的疗效及安全性。
回顾性纳入2017年1月至2019年8月间52例行后路切开手术及内固定的脊柱转移瘤患者。病例分为椎体成形术联合椎弓根螺钉（CAPS）组（28例）和CPS组（24例）。比较两组患者的基线资料[年龄、性别、手术部位、手术节段、Tomita分级、Tomita评分、Tokuhashi评分、脊柱不稳定肿瘤评分（SINS）]、手术信息及局部无进展生存期（PFS）。每位患者每3个月进行一次影像学随访。记录两组患者术前及术后3个月的视觉模拟评分（VAS）及Frankel分级，以评估疗效。记录手术时间、术中出血量、椎弓根螺钉组骨水泥注入量及手术并发症，以评估CAPS的安全性。
两组患者基线特征具有可比性。与CPS组相比，CAPS组手术时间显著延长（163±20比138±18分钟，P<0.001），VAS评分更低（2.93±1.33比4.17±1.34，P=0.002）。10例发生相邻节段椎体转移（CAPS组2例，CPS组8例，P=0.017）。8例发生内固定失败（CAPS组1例，CPS组7例，P=0.011）。与CPS组相比，CAPS组局部PFS时间显著延长（P<0.05）。
后路手术治疗脊柱转移瘤时，CAPS可能是一种安全有效的选择。
