Jang Sun Woo, Shin Hong Kyung, Jeon Sang Ryong, Roh Sung Woo, Park Danbi, Kim Chongman, Park Jin Hoon
Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Neurospine. 2025 Jun;22(2):603-612. doi: 10.14245/ns.2449230.615. Epub 2025 Apr 15.
This study compared the efficacy of posterior pedicle screw fixation with 5.5-mm rods (PPSF5.5) with anterior corpectomy (AC) for metastatic cervicothoracic junction (CTJ) tumors.
This retrospective analysis included patients with CTJ tumors who underwent PPSF5.5 or AC from January 2000 to December 2023. Data collected included demographics, surgical details, clinical outcomes (visual analogue scale scores for neck or back pain, Spinal Instability Neoplastic Scale score, McCormick scale, Nurick grade, and Eastern Cooperative Oncology Group score), radiologic results (cervical segmental Cobb angle), and surgical complications (instrumentation failure, tumor regrowth, and wound infection).
The AC group showed a tendency for short-level fusion. Patients in this group had tumors primarily located near C7 and generally confined to the vertebral body. AC was associated with more significant postoperative kyphotic changes in the index vertebra during follow-up than PPSF5.5. Moreover, AC was associated with a higher incidence of instrumentation failure, necessitating revision surgeries. Conversely, patients in the PPSF5.5 group tended to require revision surgery due to tumor regrowth.
For CTJ metastatic tumors, PPSF5.5 provides superior resistance to forward bending and collapse prevention and minimizes instrumentation failure rate compared to AC. Moreover, AC may reduce the risk of tumor recurrence, but this approach is recommended only if the tumor is confined to the vertebral body and located at the upper level of the CTJ.
本研究比较了采用5.5毫米棒的后路椎弓根螺钉固定术（PPSF5.5）与前路椎体切除术（AC）治疗转移性颈胸交界区（CTJ）肿瘤的疗效。
这项回顾性分析纳入了2000年1月至2023年12月期间接受PPSF5.5或AC治疗的CTJ肿瘤患者。收集的数据包括人口统计学资料、手术细节、临床结果（颈部或背部疼痛的视觉模拟量表评分、脊柱不稳定肿瘤量表评分、麦考密克量表、努里克分级和东部肿瘤协作组评分）、影像学结果（颈椎节段Cobb角）以及手术并发症（内固定失败、肿瘤复发和伤口感染）。
AC组显示出短节段融合的趋势。该组患者的肿瘤主要位于C7附近，且一般局限于椎体。与PPSF5.5相比，AC在随访期间与索引椎体术后后凸变化更显著相关。此外，AC与更高的内固定失败发生率相关，需要进行翻修手术。相反，PPSF5.5组的患者往往因肿瘤复发而需要翻修手术。
对于CTJ转移性肿瘤，与AC相比，PPSF5.5对前屈具有更好的抵抗力并能预防塌陷，且能将内固定失败率降至最低。此外，AC可能会降低肿瘤复发的风险，但仅当肿瘤局限于椎体且位于CTJ的较高水平时才推荐采用这种方法。
