The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale
The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale
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DOI：
10.1016/j.spinee.2015.03.040
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发表时间：
2015-08-01
期刊：
影响因子：
4.5
通讯作者：
Boszczyk, Bronek M.
中科院分区：
文献类型：
--
作者：
Quraishi, Nasir A.;Arealis, George;Boszczyk, Bronek M.
背景：以前还没有关于脊柱转移所致的不同级别的硬膜外脊髓压迫(ESCC)的手术减压(+/-稳定)结果的研究。PURPOSE：这项研究的目的是使用Bilsky六点量表来确定ESCC患者的手术治疗结果。研究设计/背景：这是一项前瞻性收集的数据的回顾性队列回顾。患者样本：连续3年在三级脊柱外科转诊单位治疗的101名因脊柱转移而接受ESCC治疗的患者。方法：年龄、性别、修订的Tokuhashi评分、术前Frankel分级、肿瘤组织学、手术前Frankel分级、肿瘤组织学、术前数据。观察两组患者手术前后的神经功能状态，比较两组患者手术前后的神经功能状态。结果：患者平均年龄64.7岁(13~88岁)，男62例，女39例。平均随访7.3个月(3~23.3个月)。原发肿瘤多位于前列腺、乳腺、肾脏、肺和血液系统。在较低的压迫程度(组1，Bilsky分级为0、1a、1b和1c；n=40)中，29例(72.5%)Frankel分级无改善，7例(17.5%)改善，4例(10%)术后神经功能恶化。在较高的压迫级别(组2；Bilsky分级2和3；n=61)中，37例(60%)患者没有神经学变化，20例(33%)有改善，而4例(7%)神经学恶化。与第二组患者相比，第一组患者术前Frankel评分较好，但第二组患者术后Frankel评分显著提高。第1组和第2组的平均修订德桥评分分别为10分和9.1分(p=.1)。第1组和第2组并发症发生率分别为25%和42.6%(P=0.052)。生存分析显示两组间无差异(组1：中位数376天[12-1052]；组2：中位数326天[12-979]；p=.62)。结论：即使脊髓受压程度较高，手术也能改善神经学。在脊柱手术中，有一种趋势是更多的并发症和更差的存活率，这些患者的压缩程度更高。(C)2015 Elsevier Inc.保留所有权利。
BACKGROUND CONTEXT: There have been no previous studies looking at the outcome of surgical decompression (+/- stabilization) for various grades of epidural spinal cord compression (ESCC) due to spinal metastases.PURPOSE: The aim of this study was to determine the outcome of surgical treatment in patients with ESCC using the Bilsky six-point scale.STUDY DESIGN/SETTING: This was a retrospective cohort review of prospectively collected data.PATIENT SAMPLE: A consecutive series of 101 patients managed over the period of 3 years for ESCC due to spinal metastases in a tertiary spine surgery referral unit were included.METHODS: Data on age, gender, revised Tokuhashi score, preoperative Frankel grade, tumor histology, magnetic resonance imaging scan-based Bilsky cord compression grade, postoperative Frankel grade at last follow-up, complications, and survivorship were collected.OUTCOME MEASURES: Frankel grading system for function was used to evaluate the patient's preoperative and postoperative neurologic status. Patient survival and postoperative complications were also collected.RESULTS: Average patient age was 64.7 years (13-88 years): 62 males and 39 females. Mean follow-up was 7.3 months (3-23.3 months). Most primary tumors were in prostate, breast, renal, lung, and the blood dyscrasias. Within the lower grade of compression (Group 1; Bilsky Grades 0,1a, 1b, and 1c; n=40), 29 patients (72.5%) had no improvement in Frankel grade, seven patients (17.5%) improved, whereas four patients (10%) deteriorated neurologically after surgery. Within the higher compression grade (Group 2; Bilsky Grades 2 and 3; n=61), 37 patients (60%) did not experience neurologic change, 20 (33%) improved, whereas neurology worsened in four patients (7%). When compared with Group 2 patients, Group 1 patients had better preoperative Frankel scores but a greater number of patients in Group 2 improved their Frankel scores significantly postoperatively. The mean revised Tokuhashi score for Groups 1 and 2 was 10 and 9.1, respectively (p=.1). The complication rate for Groups 1 and 2 was 25% and 42.6%, respectively (p=.052). Survival analysis showed no difference between the groups (Group 1: median 376 days [12-1052]; Group 2: median 326 days [12-979]; p=.62).CONCLUSIONS: Surgery can achieve improvements in neurology even in higher grades of cord compression. There is a trend toward more complications and worse survival with spinal surgery in patients with higher grades of compression. (C) 2015 Elsevier Inc. All rights reserved.