Department of Neurosurgery, University of Marburg, Marburg, Germany.
Department of Neurosurgery, Istanbul Brain and Spine Center, Istanbul, Türkiye, Turkey.
Neurosurg Rev. 2024 Oct 30;47(1):830. doi: 10.1007/s10143-024-03050-3.
This review aims to formulate the most current, evidence-based recommendations regarding complication avoidance, rehabilitation, pain therapy and palliative care for patients with metastatic spine tumors.
A systematic literature search in PubMed and MEDLINE, and was performed from 2013 to 2023 using the search terms "complications" + "spine metastases", "spine metastases" + + "rehabilitation", "spine metastases" + "pain therapy" + "palliative care". Screening criteria resulted in 35, 15 and 56 studies respectively that were analyzed. Using the Delphi method and two rounds of voting at two separate international meetings, nine members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated nine final consensus statements.
Preoperative assessment for complications following surgery in patients with metastatic spine tumors should include estimation of Karnofsky score, site of primary tumor, number of spinal and visceral metastasis, ASA score and preoperative Hb (Hemoglobin) value. Complication risk factors are age > 65 years, preoperative ASA score of 3 and 4 and greater operative blood loss. Pain management using WHO analgesic concept and early mobilization are needed, starting with non-opioids, weak opioids followed by strong opioids. Morphine is the first choice for moderate to severe pain whereas IV-PCA may be used for severe breakthrough pain with monitoring. Use of bisphosphonates is considered in cases of non-localized pain and not accessible radiation therapy.
These nine final consensus statements provide current, evidence-based guidelines on complication avoidance, rehabilitation, pain therapy and palliative care for patients with spinal metastases.
本综述旨在制定有关避免并发症、康复、疼痛治疗和姑息治疗的最新循证建议，适用于患有转移性脊柱肿瘤的患者。
在 PubMed 和 MEDLINE 中进行系统文献检索，使用搜索词“并发症”+“脊柱转移瘤”、“脊柱转移瘤”+“康复”、“脊柱转移瘤”+“疼痛治疗”+“姑息治疗”，从 2013 年至 2023 年进行搜索。筛选标准分别导致 35 项、15 项和 56 项研究被分析。使用 Delphi 方法和两轮投票，在两次单独的国际会议上，世界神经外科学会联合会（WFNS）脊柱委员会的 9 名成员生成了 9 项最终共识声明。
接受脊柱转移瘤手术的患者在术后应进行并发症发生风险的术前评估，包括 Karnofsky 评分、原发肿瘤部位、脊柱和内脏转移数量、ASA 评分和术前血红蛋白（Hb）值的评估。并发症的危险因素包括年龄>65 岁、术前 ASA 评分为 3 或 4 分以及更大的术中出血量。应使用世界卫生组织（WHO）镇痛概念和早期活动来进行疼痛管理，起始使用非阿片类药物、弱阿片类药物，然后是强阿片类药物。对于中度至重度疼痛，吗啡是首选，而对于难以控制的爆发性疼痛，可以使用静脉患者自控镇痛（IV-PCA）进行治疗，同时进行监测。对于无法进行局部放疗且存在非定位性疼痛的患者，考虑使用双膦酸盐。
这 9 项最终共识声明为脊柱转移瘤患者的并发症预防、康复、疼痛治疗和姑息治疗提供了当前的循证指南。
