Bardeesi Anas, Wilson Seth, Ward Jacob, Damante Mark, Palmer Joshua D, Xu David, Elder J Bradley, Chakravarthy Vikram B
1Department of Neurological Surgery, The Ohio State University Wexner Medical Center.
2The Ohio State University College of Medicine; and.
Neurosurg Focus. 2025 May 1;58(5):E9. doi: 10.3171/2025.2.FOCUS24994.
The concept of hybrid therapy as separation surgery, followed by stereotactic radiation therapy or stereotactic body radiation therapy, is becoming the new standard of care in the management of metastatic epidural spinal cord compressions (MESCCs). Nevertheless, this new concept remains a form of palliative treatment, and surgical efforts to minimize morbidity and prolong survival serve to maximize palliation. Such strategies include short-segment fixation with cement augmentation, described as 1 level above and below the index level of the MESCC (single vertebral body level). The use of carbon fiber-reinforced polyetheretherketone (CFRP) instrumentation has allowed precise contouring in radiation planning and earlier detection of tumor recurrence, while being biomechanically comparable to standard titanium instrumentation. Therefore, the authors wanted to explore the feasibility of short-segment cement-augmented CFRP instrumentation for patients with spinal metastasis requiring separation surgery.
A retrospective review was conducted from April 2022 to May 2024. Inclusion criteria were as follows: 1) patients who had open separation surgery for MESCC, 2) with short-segment cement-augmented CFRP instrumentation (defined as 1 level above and below the index disease level), 3) who underwent postoperative radiation therapy, with 4) a minimum 6 months of survival.
Twenty-eight patients met the inclusion criteria. The mean survival was 14.9 months, mean radiographic follow-up was 7.9 months, median estimated blood loss was 300 ml, and mean operative time was 214 minutes. There were no cement- or hardware-related complications. There were 3 cases of postoperative kyphosis, one of which was symptomatic, but all were managed nonoperatively. One patient required a reoperation for repair of a CSF leak.
Short-segment cement-augmented fixation is a feasible strategy in open separation surgery for MESCC. This is the first clinical study to incorporate the use of CFRP instrumentation in such a surgical strategy. Additional studies with larger sample sizes and longer durations of follow-up would support both the durability and potential survival benefit over titanium instrumentation.
混合治疗概念，即先行分离手术，随后进行立体定向放射治疗或立体定向体部放射治疗，正成为转移性硬膜外脊髓压迫症（MESCCs）治疗的新标准。然而，这一新概念仍是一种姑息治疗形式，旨在将手术并发症降至最低并延长生存期的手术努力，其目的是使姑息治疗效果最大化。此类策略包括采用骨水泥强化的短节段固定，即在MESCC的病变节段上下各一个节段（单个椎体节段）进行固定。使用碳纤维增强聚醚醚酮（CFRP）器械能够在放射治疗计划中实现精确塑形，并能更早地发现肿瘤复发，同时其生物力学性能与标准钛合金器械相当。因此，作者想要探讨短节段骨水泥强化CFRP器械在需要进行分离手术的脊柱转移瘤患者中的可行性。
对2022年4月至2024年5月期间的病例进行回顾性研究。纳入标准如下：1）因MESCC接受开放性分离手术的患者；2）采用短节段骨水泥强化CFRP器械固定（定义为病变节段上下各一个节段）；3）接受术后放射治疗；4）生存期至少6个月。
28例患者符合纳入标准。平均生存期为14.9个月，影像学平均随访时间为7.9个月，估计平均失血量为300毫升，平均手术时间为214分钟。未出现与骨水泥或器械相关的并发症。有3例术后出现后凸畸形，其中1例有症状，但均采用非手术治疗。1例患者因脑脊液漏需要再次手术修复。
短节段骨水泥强化固定是MESCC开放性分离手术中的一种可行策略。这是第一项将CFRP器械应用于此类手术策略的临床研究。更多样本量和更长随访时间的研究将支持其相对于钛合金器械的耐用性和潜在生存获益。
