Nather A, Bose K
Clin Orthop Relat Res. 1982 Sep(169):103-8.
The role of decompression in spinal metastases with neurologic deficit is controversial. This series demonstrates that the benefit from decompression depends on the nature of the tumor and the neurologic status of the patient. Prognosis is good for patients with incomplete paraplegia, intact sphincter control, a long duration of neurologic deficit and pain, and a gradual onset of compression. The prognosis is poor in cases with complete paraplegia, loss of sphincter control, a short duration of neurologic deficit and pain, and a sudden onset of compression. Surgery is not advocated for all cases, because many patients are already very ill. Surgery is recommended only for selective cases in which the prognosis is good. However, decompression is only palliative. Posterior decompression is preferred, inasmuch as the surgery is less extensive compared to anterior decompression and fusion.
减压在伴有神经功能缺损的脊柱转移瘤中的作用存在争议。本系列研究表明，减压的益处取决于肿瘤的性质和患者的神经功能状态。对于不全截瘫、括约肌控制功能完好、神经功能缺损和疼痛持续时间长且压迫逐渐发生的患者，预后良好。对于完全截瘫、括约肌控制功能丧失、神经功能缺损和疼痛持续时间短且压迫突然发生的病例，预后较差。并非所有病例都主张手术，因为许多患者病情已经很重。仅对预后良好的选择性病例推荐手术。然而，减压只是姑息性的。首选后路减压，因为与前路减压和融合相比，该手术范围较小。
