Surgical management of metastatic disease of the lumbar spine: experience with 139 patients
Surgical management of metastatic disease of the lumbar spine: experience with 139 patients
复制标题
DOI：
10.3171/spi.2005.2.5.0550
复制
发表时间：
2005-05-01
影响因子：
2.8
通讯作者：
Gokaslan, ZL
中科院分区：
文献类型：
--
作者：
Holman, PJ;Suki, D;Gokaslan, ZL
对象。转移性脊柱肿瘤的手术治疗是肿瘤患者综合护理的重要组成部分。在大多数大型系列研究中，研究人员都集中在胸部病变的治疗上，因为70%的病例涉及该区域。腰椎受累率较低（20%），其独特的解剖和生物力学特征是否影响手术相关结果尚不清楚。作者提出了一项对大量腰椎转移性病变患者的回顾性研究，评估了神经学和疼痛结果、并发症和生存率。作者回顾性回顾了1994年8月至2001年4月期间接受166例腰椎转移性疾病手术治疗的139例患者的资料。分析手术入路对预后的影响。在各种各样的转移性病变中，疼痛是最常见的症状（96%），包括局部疼痛、神经根疼痛和不稳定引起的轴向疼痛。根据疾病的解剖分布，患者采用前路、后路和联合入路。术后一个月，94%的病例疼痛完全或部分改善。整个人群的中位生存期为14.8个月。腰椎转移性病变的手术治疗改善了神经和行走功能，显著减少轴向脊柱疼痛；结果与其他脊柱区域的结果相当。本研究结果的分析表明，当手术入路反映疾病的解剖分布时，结果相似。然而，当需要腰椎切除术时，前路入路可减少失血和伤口相关并发症。
Object. The surgical treatment of metastatic spinal tumors is an essential component of the comprehensive care of cancer patients. In most large series investigators have focused on the treatment of thoracic lesions because 70% of cases involve this region. The lumbar spine is less frequently involved (20% cases), and it is unclear whether its unique anatomical and biomechanical features affect surgery-related outcomes. The authors present a retrospective study of a large series of patients with lumbar metastatic lesions, assessing neurological and pain outcomes, complications, and survival.Methods. The authors retrospectively reviewed data obtained in 139 patients who underwent 166 surgical procedures for lumbar metastatic disease between August 1994 and April 2001. The impact of operative approach on outcomes was also analyzed.Among the wide variety of metastatic lesions, pain was the most common presenting symptom (96%), including local pain, radicular pain, and axial pain due to instability. Patients underwent anterior, posterior, and combined approaches depending on the anatomical distribution of disease. One month after surgery, complete or partial improvement in pain was demonstrated in 94% of the cases. The median survival duration for the entire population was 14.8 months.Conclusions. The surgical treatment of metastatic lesions in the lumbar spine improved neurological and ambulatory function, significantly reducing axial spinal pain; results were comparable with those for other spinal regions. Analysis of results obtained in the present study suggests that outcomes are similar when the operative approach mirrors the anatomical distribution of disease. When lumbar vertebrectomy is necessary, however, anterior approaches minimize blood loss and wound-related complications.