Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Medical Faculty of Heidelberg University, Heidelberg, Germany.
Acta Neurochir (Wien). 2024 Aug 6;166(1):326. doi: 10.1007/s00701-024-06199-4.
The management of spinal sarcomas is complex, given their widespread involvement and high recurrence rates. Despite consensus on the need for a multidisciplinary approach with surgery at its core, there is a lack of definitive guidelines for clinical decision-making. This study examines a case series of primary spinal sarcomas, focusing on the surgical strategies, clinical results, and survival data to inform and guide therapeutic practices.
We conducted a retrospective analysis of patients who underwent surgical resection for primary spinal sarcomas between 2005 and 2022. The study focused on gathering data on patient demographics, surgical details, postoperative complications, overall hospital stay, and mortality within 90 days post-surgery.
The study included 14 patients with a primary diagnosis of spinal sarcoma, with an average age of 48.6 ± 12.6 years. Chondrosarcoma emerged as the most common tumor type, representing 57.1% of cases, followed by Ewing sarcoma at 35.7%, and synovial sarcoma at 7.1%. Patients with chondrosarcoma were treated with en-bloc resection, while the patient with synovial sarcoma underwent intra-lesional excision and those with Ewing sarcoma received decompression and tumor debulking. Postoperative assessments revealed significant improvements in neurological conditions. Notably, functional status as measured by the Karnofski Performance Index (KPI), improved substantially post-surgery (from 61.4 to 80.0%) The mean follow-up was 34.9 ± 9.2 months. During this time period one patient experienced fatal bleeding after en-bloc resection complications involving the vena cava. None of the patient needed further surgery.
Our 16-year study offers vital insights into managing primary spinal sarcomas, showcasing the effectiveness of surgical intervention, particularly en-bloc resection. Despite their rarity and complexity, our multidisciplinary treatment approach yields improved outcomes and highlights the potential for refined surgical strategies to become standardized care in this challenging domain.
由于脊柱肉瘤广泛浸润且复发率高，其治疗管理较为复杂。尽管普遍认为需要多学科治疗，以手术为核心，但目前临床决策仍缺乏明确的指导方针。本研究通过对一组原发性脊柱肉瘤病例进行分析，重点关注手术策略、临床结果和生存数据，旨在为治疗实践提供信息和指导。
我们对 2005 年至 2022 年间接受手术切除原发性脊柱肉瘤的患者进行回顾性分析。研究重点收集患者人口统计学、手术细节、术后并发症、总住院时间和术后 90 天内死亡率的数据。
研究共纳入 14 例原发性脊柱肉瘤患者，平均年龄为 48.6±12.6 岁。软骨肉瘤是最常见的肿瘤类型，占 57.1%，其次是尤文肉瘤占 35.7%，滑膜肉瘤占 7.1%。软骨肉瘤患者接受整块切除术，滑膜肉瘤患者行肿瘤内切除术，尤文肉瘤患者行减压和肿瘤切除术。术后评估显示神经状况显著改善。值得注意的是，卡氏功能状态评分（KPI）显著提高（从 61.4 分提高到 80.0 分）。平均随访时间为 34.9±9.2 个月。在此期间，1 例患者在整块切除后发生致命性静脉出血并发症。无患者需要进一步手术。
本研究通过 16 年的随访，为原发性脊柱肉瘤的治疗提供了重要的见解，展示了手术干预的有效性，特别是整块切除术。尽管脊柱肉瘤罕见且复杂，但我们的多学科治疗方法可改善预后，并有可能进一步改进手术策略，使其成为该领域的标准治疗方法。
