Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Acta Neurochir (Wien). 2024 Oct 23;166(1):423. doi: 10.1007/s00701-024-06288-4.
With the advancement of cancer treatment, appropriate treatment for musculoskeletal problems is becoming more important as it extends the patient's lifespan and improves the quality of life. In surgical treatment for metastatic spine tumors (MST), various efforts are being considered to obtain a good prognosis. The purposes of this study are to analyze prognostic factors for postoperative ambulation and perioperative complications in patients surgically treated for MST with neurologic symptoms.
Seventy five cases of patients who underwent surgery for MST with neurologic symptoms were enrolled between December 2016 and January 2023. Postoperative ambulatory function and medical complications were assessed for each patient in this study. The endpoint of ambulatory function was defined as the best function among entire periods of follow-up outpatient visits. We defined the improvement of ambulatory function as improvement in Eastern Cooperative Oncology Group (ECOG) scale. For complications, we applied complication classification system for orthopaedic surgery. Perioperative complications were defined as those requiring changes of treatment compared with routine postoperative treatment during patient's admission. Confirmed complications included expire, delirium, urinary tract infection (UTI), pneumonia, sepsis, bacteremia, acute kidney injury (AKI), chylothorax. Prognostic factors were collected and analyzed for relationship by logistic regression.
Of the 75 cases, postoperatively 42 (56%) cases of patients were improved in Nurick grade, 36 (48%) cases of patients in ECOG performance. And 21 (28%) cases of patients were treated in intensive care unit (ICU) and 15 (20%) cases of patients suffered from major perioperative complications. Regression analysis showed that clinical factors such as ECOG, psoas muscle index (PMI) and prognostic nutritional index (PNI) were related to the improvement of ambulatory function and incidence of perioperative complications. On multivariate analysis, improvement of ambulatory function was associated with PMI (p = 0.014) and incidence of perioperative complications was associated with PNI (p = 0.045).
Preoperative nutritional status and sarcopenia are related factors in the outcome of surgical treatment for MST, and preoperative efforts to improve these may be a way to obtain better clinical results.
随着癌症治疗的进步，适当治疗肌肉骨骼问题变得越来越重要，因为它可以延长患者的寿命并提高生活质量。在转移性脊柱肿瘤 (MST) 的手术治疗中，为了获得良好的预后，正在考虑各种方法。本研究的目的是分析有神经症状的 MST 患者手术治疗后术后活动能力和围手术期并发症的预后因素。
本研究纳入了 2016 年 12 月至 2023 年 1 月间因有神经症状的 MST 而行手术治疗的 75 例患者。对每位患者的术后活动能力和围手术期并发症进行评估。本研究中，活动能力的终点定义为整个随访门诊就诊期间的最佳功能。我们将活动功能的改善定义为 ECOG 量表的改善。对于并发症，我们应用骨科手术并发症分类系统。围手术期并发症定义为与患者住院期间常规术后治疗相比需要改变治疗的并发症。已确认的并发症包括死亡、谵妄、尿路感染 (UTI)、肺炎、败血症、菌血症、急性肾损伤 (AKI)、乳糜胸。收集并分析预后因素，通过逻辑回归分析其相关性。
75 例患者中，术后有 42 例（56%）患者的 Nurick 分级得到改善，36 例（48%）患者的 ECOG 表现得到改善。21 例（28%）患者在重症监护病房（ICU）治疗，15 例（20%）患者发生严重围手术期并发症。回归分析显示，ECOG、腰大肌指数（PMI）和预后营养指数（PNI）等临床因素与活动能力改善和围手术期并发症发生率相关。多变量分析显示，活动能力的改善与 PMI 相关（p=0.014），围手术期并发症的发生与 PNI 相关（p=0.045）。
术前营养状况和肌少症是 MST 手术治疗结果的相关因素，术前改善这些因素可能是获得更好临床结果的一种方法。
