Tomita K, Toribatake Y, Kawahara N, Ohnari H, Kose H
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Japan.
Paraplegia. 1994 Jan;32(1):36-46. doi: 10.1038/sc.1994.7.
We have developed a new surgical technique, 'total en bloc spondylectomy' (TES), to treat a solitary metastasis in the thoracic or lumbar vertebra. This operation is designed as a local cure for the metastatic site and involves the radical resection of the affected vertebra with a wide margin. The spondylectomy consists of two steps: en bloc laminectomy with posterior spinal instruments for stabilisation (first step) and en bloc corporectomy and replacement using a vertebral prosthesis (second step). TES makes it possible to remove the affected vertebra extracompartmentally with its tumour barrier and accomplishes circumferential decompression of the spinal cord. Before clinical practice, we constructed experimental models using cats to examine spinal cord blood flow (SCBF) after ligation of the nerve roots and circumspinal decompression. The changes of SCBF were negligible, so it was proved that TES on one vertebra has little effect on spinal cord circulation. This method was used in 24 patients. Fourteen of the 18 patients with neurological deficits improved remarkably, and the 23 evaluable cases experienced pain relief. Impending paralysis was prevented in all six patients by this surgical intervention. There has been no recurrence of the local tumour after surgery. After a median follow up period of 14.1 months, 12 patients have survived. These data suggest that TES may have a significant clinical value in the treatment of spinal metastasis.
我们研发了一种新的手术技术——“整块全脊椎切除术”（TES），用于治疗胸腰椎的孤立性转移瘤。该手术旨在对转移部位进行局部根治，包括对患椎进行广泛切缘的根治性切除。脊椎切除术包括两个步骤：使用后路脊柱器械进行整块椎板切除术以实现稳定（第一步），以及使用椎体假体进行整块椎体切除术和置换（第二步）。TES能够在椎体外将患椎及其肿瘤屏障一并切除，并实现脊髓的环形减压。在临床应用之前，我们使用猫构建了实验模型，以研究神经根结扎和环周脊髓减压后脊髓血流（SCBF）的变化。SCBF的变化可忽略不计，因此证明对一个椎体进行TES对脊髓循环影响很小。该方法应用于24例患者。18例有神经功能缺损的患者中有14例明显改善，23例可评估病例疼痛缓解。通过这种手术干预，所有6例患者的即将发生的瘫痪均得以预防。术后局部肿瘤无复发。中位随访期为14.1个月后，12例患者存活。这些数据表明，TES在脊柱转移瘤的治疗中可能具有重要的临床价值。
