| Objective: To provide theoretical basis for clinical diagnosis and therapy in spinal neoplasm. (1) To compare the clinical results of different therapeutic methods and study the prognostic factors of spinal neoplasm, and thus elaborate the therapeutic principle. (2) To study the clinical and radiological characteristics of spinal neoplasm, the principle, method and complications of preoperative CT-guided core needle biopsy technique, and thus to elaborate the diagnosis of spinal neoplasm. (3) To study the indications, the results, the complications of PVP (percutaneous vertebroplasty) and surgical treatment in spinal neoplasm.Methods: (1) 87 patients (55men and 32 women) aging from 17 to 82 (54.51 + 14. 14) years old with spinal neoplasm were analyzed retrospectively, who had been treated at Tianjin Hospital from January 1996 through November 2002. Of 87 patients, the lumbar vertebrae were involved in 32 cases, thoracic vertebrae in 27, sacral vertebrae in 20 and cervical vertebrae in 8. Among 87 patients, 60 were metastatic spinal tumors, 22 were primary malignant tumor, 5 were benign tumors or tumor-like lesions. The primary origin of 31 metastatic spinal tumors were unable to establish, and the primary focus of the tumor were known in 29 cases which were lung carcinoma in 9 cases, hepatocarcinoma in 8 cases, breast carcinoma in 3 cases, gastrointestinal carcinoma in 3 cases, prostate carcinoma in 3 cases, kidney carcinoma in 2 cases, thyroid gland carcinoma in 1 case. (2) The data including patients' age, sex, clinical features, X-ray films, CT scan, MRI, ECT characteristics, diagnosis, PVP, surgicaltreatment and something else were collected, analyzed and summarized. The data were inputted to statistics software SPSS 10. 0 and then were analyzed. (3) Pain was the predominant symptom. 34 patients presented with neurological dysfunction. Frankel grade was evaluated as grade A 1 cases, grade B 3 cases, grade C 14 cases, grade D 16 cases and grade E 53 cases. Excepting 5 raetastatic tumor cases( 3 prostate carcinoma cases and 2 breast carcinoma cases), other spinal tumors all showed osteolytic bone destruction on radiographs, CT scan and MRI. Pre-operative Tomita type was evaluated as I type in 23 cases, II type in 16cases, ITJtype in 16 cases, IV type in 13 cases, Vtype in 10 cases, VI type in 2 cases, VD type in 2 cases. CT-guided needle biopsy were main method of biopsy. () The indications, methods and results of PVP and surgical treatment were analyzed and summarized respectively. PVP was performed for vertebral haemangioma in 3 cases, vertebral metastases in 15 cases (19 vertebras) and myeloma in 3 cases (4 vertebras). The CT scan was obtained after intervention to assess the lesion filling and cement leaking. 31 cases were treated by surgical treatment among the 87 cases. The lesions were located at cervical spines in 3 cases, thoracic spines in 9 cases, lumbar spines in 9 cases and sacrum in 10 cases. Pre-operative Frankel grade was evaluated as grade A 1 case, grade B 3 cases, grade C 11 cases, grade D 12 cases and grade E 4 cases. The patients underwent anterior, posterior or staged antero-posterior operations based on the location of lesions in the spine, endurance of the patients, life expectancy and so on. Among of them, 20 cases were adopted vertebral reconstruction and internal fixation depending on the conditions.Results: (1) 87 patients were treated in our hospital lasting from 4 to 97(27. 85+15. 89) days. 52 patients recovered and 32 patients did not when they left our hospital. The ratio of recovered patients of the 87 patients was 59. 77%, metastatic spinal tumors 55. 00%, primary malignant tumor 63. 64%, benign tumors and tumor-like lesions 80. 00%. The ratio of recovered patients who were treated by PVP or surgical treatment were obviously increased than that who were treated by nonsurgical methods (P<0. 01) . There was not significant difference in ratio of recovered patients between the group of PVP and that of surgical operation(P>0. 05). The Binary Logistic Regressio... |
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