Wang C S, Atan Z
Department of Orthopaedics, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia.
Malays Orthop J. 2024 Nov;18(3):32-41. doi: 10.5704/MOJ.2411.005.
Surgical treatment for indicated spinal metastases cases is an option to improve patients' outcomes. Local data in analysing the potential of patients' improvement after surgical treatment are limited. We intend to review the clinical outcomes of surgeries performed for cancer patients who were diagnosed with spinal metastases. We aim to identify factors associated with improved spinal pain, neurological deficit and patient survival.
The medical records of 51 patients who were diagnosed with thoracolumbar spinal metastatic tumour and underwent palliative single-stage posterior approach spinal surgery between June 2015 and June 2022 were recruited retrospectively. Patient demographic data, pre-operative and post-operative pain scores, neurological assessment and survival duration were collected from the medical records. Radiological findings were studied using respective imaging and reports.
The mean age was 57.5 years, and the median survival was nine months after the surgical treatment. The post-operative pain improvements were statistically significant at two weeks (VAS improved from 5 to 2), and three months follow-up VAS was one (p<0.001 and p=0.009, respectively). At initial presentation, patients with a single-level spinal involvement had higher VAS compared to multiple spinal metastases (p=0.018). A total of 18 (35.3%) patients had improved one or more ASIA grades, of which eight (15.7%) of them had gain of ambulatory function (p<0.001). Twenty-seven (52.9%) patients were ambulatory post-operative. The slow growth type of primary carcinoma, post-operative ambulatory ability, and the absence of perioperative morbidity were factors associated with favourable survival duration (p=0.006, p<0.001 and p<0.001, respectively). Synchronous visceral metastases adversely affected the survival duration (p=0.008).
Single-stage posterior decompression and stabilisation improved the clinical outcomes of spinal pain and neurological deficit in metastatic spinal tumours. Type of primary tumour, visceral metastasis, perioperative morbidity, and post-operative ambulatory status significantly impact post-operative survival duration.
对于有指征的脊柱转移瘤病例，手术治疗是改善患者预后的一种选择。分析手术治疗后患者改善潜力的本地数据有限。我们旨在回顾为诊断为脊柱转移瘤的癌症患者进行手术的临床结果。我们的目标是确定与脊柱疼痛改善、神经功能缺损和患者生存相关的因素。
回顾性纳入2015年6月至2022年6月期间诊断为胸腰椎脊柱转移瘤并接受姑息性单阶段后路脊柱手术的51例患者的病历。从病历中收集患者人口统计学数据、术前和术后疼痛评分、神经功能评估和生存时间。使用各自的影像学检查和报告研究影像学结果。
平均年龄为57.5岁，手术治疗后的中位生存期为9个月。术后两周疼痛改善具有统计学意义（视觉模拟评分法（VAS）从5分改善至2分），三个月随访时VAS为1分（分别为p<0.001和p=0.009）。初次就诊时，单节段脊柱受累患者的VAS高于多节段脊柱转移患者（p=0.018）。共有18例（35.3%）患者的美国脊髓损伤协会（ASIA）分级改善了一级或更多，其中8例（15.7%）获得了行走功能（p<0.001）。27例（52.9%）患者术后可行走。原发癌的缓慢生长类型、术后行走能力以及无围手术期并发症是与良好生存期相关的因素（分别为p=0.006、p<0.001和p<0.001）。同时性内脏转移对生存期有不利影响（p=0.008）。
单阶段后路减压和稳定术改善了转移性脊柱肿瘤患者的脊柱疼痛和神经功能缺损的临床结果。原发肿瘤类型、内脏转移、围手术期并发症和术后行走状态对术后生存期有显著影响。
