Gokaslan Z L, York J E, Walsh G L, McCutcheon I E, Lang F F, Putnam J B, Wildrick D M, Swisher S G, Abi-Said D, Sawaya R
Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
J Neurosurg. 1998 Oct;89(4):599-609. doi: 10.3171/jns.1998.89.4.0599.
Anterior approaches to the spine for the treatment of spinal tumors have gained acceptance; however, in most published reports, patients with primary, metastatic, or chest wall tumors involving cervical, thoracic, or lumbar regions of the spine are combined. The purpose of this study was to provide a clear perspective of results that can be expected in patients who undergo anterior vertebral body resection, reconstruction, and stabilization for spinal metastases that are limited to the thoracic region.
Outcome is presented for 72 patients with metastatic spinal tumors who were treated by transthoracic vertebrectomy at The University of Texas M. D. Anderson Cancer Center. The predominant primary tumors included renal cancer in 19 patients, breast cancer in 10, melanoma or sarcoma in 10, and lung cancer in nine patients. The most common presenting symptoms were back pain, which occurred in 90% of patients, and lower-extremity weakness, which occurred in 64% of patients. All patients underwent transthoracic vertebrectomy, decompression, reconstruction with methylmethacrylate, and anterior fixation with locking plate and screw constructs. Supplemental posterior instrumentation was required in seven patients with disease involving the cervicothoracic or thoracolumbar junction, which was causing severe kyphosis. After surgery, pain improved in 60 of 65 patients. This improvement was found to be statistically significant (p < 0.001) based on visual analog scales and narcotic analgesic medication use. Thirty-five of the 46 patients who presented with neurological dysfunction improved significantly (p < 0.001) following the procedure. Thirty-three patients had weakness but could ambulate preoperatively. Seventeen of these 33 regained normal strength, 15 patients continued to have weakness, and one patient was neurologically worse postoperatively. Of the 13 preoperatively nonambulatory patients, 10 could walk after surgery and three were still unable to walk but showed improved motor function. Twenty-one patients had complications ranging from minor atelectasis to pulmonary embolism. The 30-day mortality rate was 3%. The 1-year survival rate for the entire study population was 62%.
These results suggest that transthoracic vertebrectomy and spinal stabilization can improve the quality of life considerably in cancer patients with spinal metastasis by restoring or preserving ambulation and by controlling intractable spinal pain with acceptable rates of morbidity and mortality.
脊柱前路手术治疗脊柱肿瘤已被广泛接受；然而，在大多数已发表的报告中，涉及颈椎、胸椎或腰椎区域的原发性、转移性或胸壁肿瘤患者被合并在一起。本研究的目的是明确对于局限于胸椎区域的脊柱转移瘤患者，接受前路椎体切除、重建和稳定手术后可能预期的结果。
报告了得克萨斯大学MD安德森癌症中心72例接受经胸椎体切除术治疗的转移性脊柱肿瘤患者的结果。主要原发肿瘤包括19例肾癌、10例乳腺癌、10例黑色素瘤或肉瘤以及9例肺癌。最常见的首发症状是背痛，90%的患者出现背痛，64%的患者出现下肢无力。所有患者均接受经胸椎体切除术、减压、甲基丙烯酸甲酯重建以及锁定钢板和螺钉结构的前路固定。7例疾病累及颈胸或胸腰段交界处并导致严重后凸畸形的患者需要补充后路内固定。术后，65例患者中有60例疼痛得到改善。根据视觉模拟量表和麻醉性镇痛药使用情况，这种改善具有统计学意义（p < 0.001）。46例出现神经功能障碍的患者中有35例术后明显改善（p < 0.001）。33例患者术前有肌无力但可行走。这33例患者中有17例恢复了正常肌力，15例仍有肌无力，1例患者术后神经功能恶化。13例术前不能行走的患者中，10例术后可行走，3例仍不能行走但运动功能有所改善。21例患者出现了从轻度肺不张到肺栓塞等并发症。30天死亡率为3%。整个研究人群的1年生存率为62%。
这些结果表明经胸椎体切除术和脊柱稳定术可以通过恢复或保留行走能力以及以可接受的发病率和死亡率控制顽固性脊柱疼痛，显著提高脊柱转移癌患者的生活质量。
