Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopedics, People's Fourth Hospital of Sichuan Province, Chengdu, China.
Orthop Surg. 2024 Jun;16(6):1292-1299. doi: 10.1111/os.14063. Epub 2024 Apr 21.
There is still controversy over the choice of treatment for end-stage spinal metastases. With the continuous development of microwave technology in spinal tumors, related studies have reported that microwave combined with techniques such as pedicle screw fixation and percutaneous vertebroplasty can achieve the purpose of tumor ablation, relieving spinal cord compression, enhancing spinal stability, effectively relieving pain, and reducing recurrence rates. This study aimed to analyze the effectiveness of microwave ablation combined with decompression and pedicle screw fixation in the palliative management of spinal metastases with pathological fractures.
This retrospective study enrolled 82 patients with spinal metastases and pathological fractures treated between January 2016 and July 2020, with 44 patients undergoing pedicle screw fixation along with laminectomy (fixation group) and the remaining 38 receiving microwave ablation in addition to the treatment provided to group fixation (MWA group). Before surgery, all patients underwent pain assessment using the visual analogue scale (VAS) and evaluation of spinal cord injury using the Frankel classification. After surgery, the patients' prognoses were assessed using the Tomita score, modified Tokuhashi score system, and progression-free survival. Additionally, we compared operative time and blood loss between the two groups. Survival analysis utilized the Kaplan-Meier method with a log-rank test for group comparisons. Paired t-tests and the Mann-Whitney U test were applied to metric and non-normally distributed data, respectively. Neurological function improvement across groups was evaluated using the χ test.
All patients were followed up for a median duration of 18 and 20 months in the fixation and MWA groups, respectively, with follow-up periods ranging from 6 to 36 months. Statistically significant reductions in postoperative VAS scores were observed in all patients compared with their preoperative scores. The MWA group exhibited reduced blood loss (t = 2.74, p = 0.01), lower VAS scores at the 1- and 3-month follow-ups (t = 2.34, P = 0.02; t = 2.83, p = 0.006), and longer progression-free survival than the fixation group (p = 0.03). Although the operation times in the MWA group were longer than those in the fixation group, this difference was not statistically significant (t = 6.06, p = 0.12). No statistically significant differences were found regarding improvements in spinal cord function between the two groups (p = 0.77).
Compared with decompression and pedicle screw fixation for treating spinal metastases with pathological fractures, microwave ablation combined with decompression and pedicle screw fixation showed better outcomes in terms of pain control, longer progression-free survival, and lower blood loss without increasing operative time, which has favorable implications for clinical practice.
对于终末期脊柱转移瘤的治疗选择仍存在争议。随着微波技术在脊柱肿瘤中的不断发展，相关研究表明，微波联合椎弓根螺钉固定和经皮椎体成形术等技术可达到肿瘤消融、缓解脊髓压迫、增强脊柱稳定性、有效缓解疼痛和降低复发率的目的。本研究旨在分析微波消融联合减压和椎弓根螺钉固定治疗病理性骨折脊柱转移瘤的疗效。
本回顾性研究纳入了 2016 年 1 月至 2020 年 7 月期间接受治疗的 82 例脊柱转移瘤合并病理性骨折患者，其中 44 例患者接受椎弓根螺钉固定加椎板切除术（固定组），其余 38 例患者接受微波消融加固定组治疗（MWA 组）。术前所有患者均采用视觉模拟评分法（VAS）评估疼痛，采用 Frankel 分级评估脊髓损伤。术后采用 Tomita 评分、改良 Tokuhashi 评分系统和无进展生存率评估患者预后。此外，我们比较了两组的手术时间和失血量。生存分析采用 Kaplan-Meier 法，对数秩检验进行组间比较。计量资料和非正态分布资料分别采用配对 t 检验和 Mann-Whitney U 检验。组间神经功能改善采用 χ²检验。
固定组和 MWA 组的患者分别随访 18 个月和 20 个月，随访时间为 6 至 36 个月。与术前相比，所有患者术后 VAS 评分均显著降低。与固定组相比，MWA 组的失血量更少（t=2.74，p=0.01），术后 1 个月和 3 个月的 VAS 评分更低（t=2.34，P=0.02；t=2.83，p=0.006），无进展生存率更长（p=0.03）。虽然 MWA 组的手术时间长于固定组，但差异无统计学意义（t=6.06，p=0.12）。两组脊髓功能改善无统计学差异（p=0.77）。
与单纯减压和椎弓根螺钉固定治疗脊柱转移瘤合并病理性骨折相比，微波消融联合减压和椎弓根螺钉固定在控制疼痛、延长无进展生存率和降低失血量方面具有更好的效果，而不增加手术时间，这对临床实践具有积极意义。
