Segi Naoki, Nakashima Hiroaki, Ito Sadayuki, Ouchida Jun, Shiratani Yuki, Shimizu Takaki, Suzuki Akinobu, Terai Hidetomi, Kakutani Kenichiro, Kanda Yutaro, Tominaga Hiroyuki, Kawamura Ichiro, Ishihara Masayuki, Paku Masaaki, Takahashi Yohei, Funaba Masahiro, Funayama Toru, Nakajima Hideaki, Akeda Koji, Hirai Takashi, Inoue Hirokazu, Nakanishi Kazuo, Funao Haruki, Oshigiri Tsutomu, Otsuki Bungo, Kobayakawa Kazu, Tanishima Shinji, Hashimoto Ko, Iimura Takuya, Sawada Hirokatsu, Uotani Koji, Manabe Hiroaki, Iwai Chizuo, Yamabe Daisuke, Hiyama Akihiko, Seki Shoji, Goto Yuta, Miyazaki Masashi, Watanabe Kazuyuki, Nakamae Toshio, Kaito Takashi, Nagoshi Narihito, Kato Satoshi, Watanabe Kota, Imagama Shiro, Inoue Gen, Furuya Takeo
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopaedic Surgery, Chiba University Hospital, Chiba, Japan.
Global Spine J. 2025 May;15(4):2286-2299. doi: 10.1177/21925682241297948. Epub 2024 Nov 1.
Study DesignProspective multicenter study.ObjectivesPalliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments.MethodsWe prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper-middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared.ResultsAll groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9).ConclusionsPalliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.
研究设计
前瞻性多中心研究。
目的
姑息性手术对于维持脊柱转移瘤患者的生活质量（QOL）至关重要。本研究旨在比较不同节段转移性脊柱肿瘤患者姑息性手术后生活质量的短期结果。
方法
我们前瞻性地比较了203例连续2 - 3个节段发生脊柱转移的患者的数据，这些患者被分为以下三组：颈椎组，颈椎病变患者；胸椎组，胸段中上段病变患者；胸腰/腰/骶组，胸腰段交界处及腰骶部病变患者。比较术前和术后欧洲五维健康量表（EQ5D）5级评分。
结果
所有组术后Frankel分级、体能状态、疼痛、Barthel指数、EQ5D健康状态效用值（HSUV）和EQ5D视觉模拟量表（VAS）均有改善。虽然术前各组EQ5D HSUV无显著差异（颈椎组，0.461±0.291；胸椎组，0.321±0.292；胸腰/腰/骶组，0.376±0.272），但胸椎组术后EQ5D HSUV显著低于其他两组（颈椎组，0.653±0.233；胸椎组，0.513±0.252；胸腰/腰/骶组，0.624±0.232）。然而，术后各组EQ5D VAS无显著差异（颈椎组，63.4±25.8；胸椎组，54.7±24.5；胸腰/腰/骶组，61.7±21.9）。
结论
转移性脊柱肿瘤的姑息性手术无论涉及哪个脊柱节段，均可提供相当的生活质量改善。胸段中上段脊柱转移患者比其他节段转移患者的生活质量结果更差；然而，生活质量仍有足够改善。
