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| QIU Yiyun,YANG Sizhen,ZHANG Ying.Observation on the curative effect of hybrid separation surgery for the treatment of thoracic and lumbar vertebra metastasis with spinal cord compression symptoms[J].Chinese Journal of Spine and Spinal Cord,2021,(2):120-126. |
| Observation on the curative effect of hybrid separation surgery for the treatment of thoracic and lumbar vertebra metastasis with spinal cord compression symptoms |
| Received:October 12, 2020 Revised:January 24, 2021 |
| English Keywords:Spinal metastasis Hybrid separation surgery Spinal cord compression Clinical effect |
| Fund:国家自然科学基金（基金号：81570800）；国家自然科学青年基金（基金号：81501853） |
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| English Abstract: |
| 【Abstract】 Objectives: To evaluate the clinical efficacy of hybrid separation surgery in the treatment of thoracic and lumbar vertebra metastasis with spinal cord compression symptoms. Methods: Retrospective analysis was performed on the clinical data of 28 patients with thoracolumbar metastatic tumors associated with spinal cord compression that underwent surgical treatment. They were admitted to our hospital from June 2013 to June 2018. There were 18 males and 10 females with an average age of 57.0±10.8 years(41-77 years). According to the primary tumor types: 12 cases were of lung adenocarcinoma, 2 of lung squamous cell carcinoma, 1 of pulmonary neuroendocrine carcinoma, 6 of rectal adenocarcinoma, 3 of renal clear cell carcinoma, 2 of breast cancer, 1 of hepatocellular carcinoma, and 1 of prostate cancer. According to the site of the tumor in spine: 13 cases were of single thoracic vertebral metastasis, 11 of single lumbar spine metastasis, 2 of multiple thoracic vertebral metastasis, 1 of multiple lumbar vertebra metastasis, and 1 of thoracolumbar spine metastasis. Preoperative Frankel grade: 1 case was grade A, 5 cases were grade B, 6 cases were grade C, and 16 cases were grade D; Visual analogue scale(VAS) score was 7.3±0.8, Tomita score was 5.9±0.9 (4-7); Preoperative epidural spinal cord compression(ESCC) grade 1b score was in 3 cases, 9 cases were of grade 1c, 8 cases were of grade 2, and 8 cases were of grade 3. All patients underwent hybrid separation surgery. The specific methods include posterior approach partial decompression of vertebral tumor, bone cement titanium mesh support, bone cement filling and sealing, and pedicle screw fixation. The operation time, intraoperative blood loss, postoperative hospitalization days, Frankel gradings immediately after surgery and 3 months postoperatively, the VAS scores and the Eastern Cooperative Oncology Group(ECOG) physical status scores at 7 days and 3 months after surgery, intraoperative and postoperative complications, and survival time of the patients were collected for statistics. Results: The average operative time was 202.0±34.7min (140-285min), the average intraoperative blood loss was 819.6±150.0ml(500-1100ml), and the average postoperative hospital stay was 13.2±3.9 days(7-22 days). Intraoperative and postoperative complications: cerebrospinal fluid leakage in 3 cases, incision infection in 3 cases, urinary tract infection in 1 case, pulmonary infection in 1 case, postoperative acute nerve root stimulation in 3 cases, and titanium mesh displacement in 1 case at 12 months follow-up. The VAS scores and ECOG scores at 7 days and 3 months after operation were significantly improved compared with those before operation(P<0.05). The median follow-up time of the patients in this group was 20.5 months(6-42 months), and the mean follow-up time was 21.3±10.0 months. There were 6 patients alive at the last follow-up. Among them, 1 patient had new metastasis at 30 months after the operation, and the patient was alive with tumor after a second operation, with the survival time at the last follow-up of 38 months. Conclusions: Hybrid separation surgery for thoracolumbar metastatic tumors with spinal cord compression symptoms can significantly relieve spinal cord compression, improve neurological function, relieve pain, and improve the quality of life. |
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