Cobb C A, Leavens M E, Eckles N
J Neurosurg. 1977 Nov;47(5):653-8. doi: 10.3171/jns.1977.47.5.0653.
A retrospective series of 12,478 patients with breast cancer included 2467 patients with spinal metastases. Local treatment was not necessary in 688 patients. Neurological dificit did not develop in 1735 patients who underwent radiotherapy. Forty-four patients developed myelopathy due to spinal cord compression as demonstrated by neurological examination and myelography. Twenty-six of these patients were initially treated by laminectomy and 18 were initially treated with radiotherapy. The two groups did not significantly differ in their outcome with respect to motor power, pain relief, or ability to walk. Six patients who underwent radiotherapy deteriorated during 2 months of treatment. Four of these patients were not operative candidates because of poor general condition (three patients) or long duration of paraplegia (one patient). Of two patients who underwent emergency laminectomy, one became paraplegic; however, the other patient was significantly improved. For this reason it is essential that patients undergoing radiotherapy for spinal cord compression be followed closely by a neurosurgeon. The authors believe that in appropriate cases radiotherapy alone can yield results as good as laminectomy combined with radiotherapy.
一项对12478例乳腺癌患者的回顾性研究系列中，有2467例患者发生脊柱转移。688例患者无需进行局部治疗。1735例接受放疗的患者未出现神经功能缺损。44例患者经神经检查和脊髓造影证实因脊髓压迫而发生脊髓病。其中26例患者最初接受椎板切除术治疗，18例最初接受放疗。两组在运动能力、疼痛缓解或行走能力方面的结果无显著差异。6例接受放疗的患者在治疗的2个月内病情恶化。其中4例患者因全身状况差（3例患者）或截瘫时间长（1例患者）而不适合手术。在接受急诊椎板切除术的2例患者中，1例变成截瘫；然而，另1例患者明显好转。因此，对于因脊髓压迫接受放疗的患者，神经外科医生必须密切随访。作者认为，在适当的病例中，单纯放疗可产生与椎板切除术联合放疗一样好的效果。
