Onimus M, Schraub S, Bertin D, Bosset J F, Guidet M
Spine (Phila Pa 1976). 1986 Nov;11(9):883-91. doi: 10.1097/00007632-198611000-00007.
Fifty-seven patients with spinal metastases underwent 60 operations. 36 patients were operated on by anterior approach with decompressive coporectomy and stabilization by metal and methylmetacrylate and 24 patients by laminectomy and/or stabilization by osteosynthesis. Postoperative improvement of the pain syndrome was observed after 56 operations. Neurologic signs were present in 23 patients with paraplegia (5 patients) or paraparesis (18 patients); 15 of the latter patients improved and recovered walking capacity. Two types of metastasis were distinguished: corporal metastasis, in which vertebral wedging and posterior protrusion led to neural deficit, with a good prognosis if treated by anterior surgery, and pericordal metastasis in which the cord compression is due to metastatic proliferation into the spinal canal. Results after decompressive surgery, either by posterior or anterior approaches are more doubtful. Surgery is beneficial and should be preferred to radiation when there is medullary compression by corporal metastasis and also in the presence of intense pain or potential instability of the spine.
57例脊柱转移瘤患者接受了60次手术。36例患者采用前路手术，行减压性椎体切除术，并使用金属和甲基丙烯酸甲酯进行稳定固定；24例患者行椎板切除术和/或采用骨固定术进行稳定固定。56次手术后观察到疼痛综合征有所改善。23例患者存在神经体征，其中5例截瘫，18例轻瘫；后者中有15例症状改善并恢复了行走能力。区分出两种转移类型：椎体转移，其中椎体楔形变和后凸导致神经功能缺损，前路手术治疗预后良好；以及脊髓周围转移，其中脊髓受压是由于转移瘤向椎管内增殖所致。后路或前路减压手术后的结果更难以确定。当存在椎体转移导致的髓质受压以及剧烈疼痛或脊柱潜在不稳定时，手术是有益的，应优先于放疗。
