Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey.
Department of Neurosurgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey.
World Neurosurg. 2024 Sep;189:e794-e806. doi: 10.1016/j.wneu.2024.07.008. Epub 2024 Jul 6.
The estimation of survival is extremely important for metastatic disease in the spine. The aim of this study was to determine the factors affecting the outcome of patients with spinal metastasis, primarily the character of neurologic deficit and the histopathology of the tumor.
A retrospective examination was made of 158 patients with spinal metastasis who were followed up in our clinic between 2010 and 2020 and underwent surgical intervention. The patients were examined in respect of demographic characteristics, the primary tumor, comorbidities, preoperative-postoperative visual aAnalog scale scores, preoperative-postoperative neurologic examinations and neurologic deficit if present and ambulation status, postoperative survival duration, tumor localization, characteristics of the surgeries, complications, the Karnofsky Performance Scale, revised Tokuhashi, and Tomita scores.
Spinal metastasis was seen more frequently in males (72.8% male, 27.8% female). Male gender, multiple level involvement, intradural localization, and Karnofsky Performance Scale <70 were seen to cause a shorter survival time. Patients with a primary focus of hematologic malignancy, breast cancer, and lymphoma had a longer survival. The revised Tokuhashi and Tomita scores were observed to be successful in the prediction of survival. A decrease in postoperative visual analog scale score had a positive effect on functional survival. The absence of preoperative neurological deficit and the patient's ability for preoperative and postoperative ambulation affected survival positively. The overall survival period decreased in patients who were mobilized in the early postoperative period but became nonmobile in the late period, and in those who were nonmobile in both the early and late postoperative periods.
The neurologic and ambulatory status, the Tomita and Tokuhashi scores, intradural localization, and gender are the factors with a significant effect on prognosis.
对于脊柱转移瘤，生存估计至关重要。本研究旨在确定影响脊柱转移瘤患者预后的因素，主要是神经功能缺损的特征和肿瘤的组织病理学。
对 2010 年至 2020 年在我院接受手术治疗的 158 例脊柱转移瘤患者进行回顾性检查。对患者的人口统计学特征、原发病灶、合并症、术前-术后视觉模拟量表评分、术前-术后神经检查及存在的神经功能缺损和活动状态、术后生存时间、肿瘤定位、手术特点、并发症、卡诺夫斯基绩效量表、改良 Tokuhashi 评分和 Tomita 评分进行了检查。
脊柱转移瘤在男性中更为常见（72.8%为男性，27.8%为女性）。男性、多节段受累、硬膜内定位和卡诺夫斯基绩效量表<70 与生存时间缩短有关。原发灶为血液恶性肿瘤、乳腺癌和淋巴瘤的患者生存时间较长。改良 Tokuhashi 和 Tomita 评分被认为可成功预测生存。术后视觉模拟量表评分降低对功能生存有积极影响。术前无神经功能缺损和患者术前、术后活动能力对生存有积极影响。术后早期活动能力正常但晚期活动能力丧失的患者，以及术后早期和晚期活动能力均丧失的患者，总生存时间缩短。
神经和活动状态、Tomita 和 Tokuhashi 评分、硬膜内定位和性别是对预后有显著影响的因素。
