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The Role of Stabilization-Free Microsurgical Decompression in the Surgical Treatment of Spinal Metastases.

无稳定显微外科减压术在脊柱转移瘤手术治疗中的作用。

  • 影响因子:1.52
  • DOI:10.1016/j.wneu.2019.09.083
  • 作者列表:"Müller M","Abusabha Y","Steiger HJ","Petridis A","Bostelmann R
  • 发表时间:2020-01-01
Abstract

OBJECTIVE:Symptomatic spine metastases are found in about 10% of patients with cancer. As the long-term survival of patients with carcinoma rises, the number of patients with symptomatic spine metastases is also increasing. In our tertiary referral center, patients usually present rapidly progressive neurologic disorders, which require an urgent treatment decision. Treatment options include extensive 360° stabilizations. These complex interventions are not always readily available. We examined the extent to which the patient population benefited from decompressive surgery without stabilization. We hypothesize that patients benefit from merely dorsal decompression, which preserves stability when they experience symptomatic spine metastases. METHODS:We performed a retrospective analysis of electronic patient data from 19 patients, who were treated for symptomatic spine metastases by hemilaminectomy between 2009 and 2017. We evaluated the preoperative and postoperative neurologic functions using the American Spinal Injury Association (ASIA) Impairment Scale. A comparative literature analysis was carried out to assess the Spinal Neoplastic Instability Score, Tokuhashi score, and Tomita score. RESULTS:Nine participants had prostate cancer, 4 had mammary carcinoma, 3 had bronchial carcinoma, and 3 had other cancers. The median preoperative ASIA score was C, postoperatively, the score significantly improved to D (sign test P = 0.002). None of the patients needed stabilization within the follow-up period of up to 56 months. CONCLUSIONS:In our patient population, minimal intervention could significantly improve neurologic disorders. This outcome was seen over the whole study period. Even though different scoring systems suggest stabilization, our results show that spinal decompression alone might be indicated as well.

摘要

目的: 约 10% 的癌症患者出现症状性脊柱转移。随着癌症患者长期生存率的提高,有症状的脊柱转移患者也在增加。在我们的三级转诊中心,患者通常呈现快速进展的神经系统疾病,需要紧急治疗决定。治疗选择包括广泛的 360 ° 稳定。这些复杂的干预措施并不总是现成的。我们检查了患者人群从无稳定的减压手术中获益的程度。我们假设患者仅受益于背侧减压术,当患者出现症状性脊柱转移时,背侧减压术可保持稳定性。 方法: 我们对 2009 年至 2017 年间接受半椎板切除术治疗的 19 例症状性脊柱转移患者的电子患者资料进行了回顾性分析。我们使用美国脊髓损伤协会 (ASIA) 损伤量表评估了术前和术后神经功能。进行比较文献分析,评估脊柱肿瘤性不稳定评分、Tokuhashi评分和Tomita评分。 结果: 9 例受试者患有前列腺癌,4 例患有乳腺癌,3 例患有支气管癌,3 例患有其他癌症。中位术前ASIA s c矿石C,术后,用来衡量加拿大多伦多s c矿石显著c antly提高到D (签test P = 0.002).在长达 56 个月的随访期内,没有患者需要稳定。 结论: 在我们的患者人群中,最小干预可以显著改善神经系统疾病。在整个研究期间观察到这一结果。尽管不同的评分系统提示稳定,但我们的结果表明,单独的脊柱减压也可能被指示。

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作者列表:["Tran S","Puric E","Walser M","Poel R","Datta NR","Heuberger J","Pica A","Marder D","Lomax N","Bolsi A","Morach P","Bachtiary B","Seddon BM","Schneider R","Bodis S","Weber DC"]

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
发表时间:2020-01-01
DOI:10.1007/s00520-019-04843-9
作者列表:["Dohzono S","Sasaoka R","Takamatsu K","Hoshino M","Nakamura H"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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