Hosono N, Yonenobu K, Fuji T, Ebara S, Yamashita K, Ono K
Department of Orthopaedic Surgery, Center for Adult Diseases, Osaka, Japan.
Clin Orthop Relat Res. 1995 Mar(312):148-59.
Spinal metastases result in severe spinal pain, neurologic deficits, or both. These symptoms usually are caused by spinal instability, in which conservative therapy can have no effect, and surgical treatment is required to restabilize the destroyed spinal segments. Surgical indications are instability of the spine, pain and/or paresis resistant to radiation therapy, acute progressing paresis, and unknown histologic diagnosis. There are 2 surgical approaches for vertebral metastases: prosthetic replacement and posterior stabilization. Single or 2 consecutive diseased vertebrae should be treated with replacement surgery. In this series, excellent surgical outcome was attained with this procedure, and surgical benefit was maintained until the terminal stage of each patient. Multiple vertebral metastases are treated with posterior stabilization using various instrumentation systems that provide rigid stabilization. To choose the most appropriate procedure for each patient, the local condition of the lesion and general status of the patient, including prediction of life expectancy, should be evaluated fully. Spinal metastases develop early and are not terminal events. Therefore, not only palliative treatment but also surgical intervention should be considered for spinal metastases when indicated.
脊柱转移瘤会导致严重的脊柱疼痛、神经功能缺损或两者皆有。这些症状通常由脊柱不稳定引起，而保守治疗对此可能无效，需要进行手术治疗以重新稳定被破坏的脊柱节段。手术指征包括脊柱不稳定、对放射治疗耐药的疼痛和/或轻瘫、急性进行性轻瘫以及组织学诊断不明。治疗椎体转移瘤有两种手术方法：假体置换和后路稳定术。单个或连续两个患病椎体应采用置换手术治疗。在本系列研究中，该手术取得了优异的手术效果，且手术益处一直维持到每位患者的终末期。多个椎体转移瘤采用后路稳定术治疗，使用各种提供坚强稳定的内固定系统。为每位患者选择最合适的手术方法时，应全面评估病变的局部情况和患者的一般状况，包括预期寿命的预测。脊柱转移瘤发展较早，并非终末期事件。因此，当有指征时，对于脊柱转移瘤不仅应考虑姑息治疗，还应考虑手术干预。
