Radiofrequency Ablation Combined With Vertebral Analysis Of Plastic Surgery And The Finite Segment Of Spinal Canal Decompression And Internal Fixation For Treatment Of Thoracolumbar Vertebral Metastases

Objective: Spinal tumor incidence increased year by year, in mostprevious treatmentthoracolumbar tumor, spinal tumors by conservativetreatment, such as radiotherapy,chemotherapy, operation treatment islimited to a palliative simple laminectomy. In recent years,along with thePVP and the maturity of RFA technology, we can provide patients withpossible small trauma and curative effect as much as possible. The studyof radiofrequency ablationcombined with analysis of plastic surgery andthe finite segment of spinal canal decompression and internal fixation fortreatment of thoracolumbar vertebral metastases percutaneousvertebroplasty, and to provide a scientific basis for clinical application.Methods:19cases of patients with metastatic tumor in our departmentof thoracolumbar vertebrae from June to2013in2011June, including8cases of male, female11cases, expected survival time was more than halfa year, age45-70year old, average58.05±9.15. All cases wereconfirmed by postoperative pathological results confirmed the vertebralmetastases, vertebral metastasis and invasion by MRI and CTexamination, including lung cancer(5), hepatocellular carcinoma (2)esophageal cancer(1), gastric cancer9(2), renal cell carcinoma (2), breastcancer (4), prostate cancer (2), unknown origin(1). Symptoms of localpain,involvement level below the different degree of nerve rootinvolvement. According to the standardmethod for the evaluation ofFranke1,3cases of Grade A, grade B5cases, C grade7cases, D grade2cases, E grade2cases.Preoperative examinations included: blood, urine, stool routine, liver and kidney function, the analysis of blood coagulation function, blood gas,electrocardiogram, chest X-ray, ultrasound,abdominal ultrasound, lungfunction, when necessary, check the thoracic and abdominal CT,gastricPET/CT clear primary lesions. Please consultations, remove operationtaboos. Blood pressure control in the160/100mmHg, blood glucosecontrol in6.0mmol/L. With bisphosphonatesinhibit bone destruction.Patients with preoperative fasting one day water, cleaning enema, half anhour before operation, intravenous infusion of antibiotics to preventinfection.Radiofrequency ablation combined with vertebroplasty and finitesegment of spinal canal decompression and internal fixation. Routinepostoperative ECG, blood oxygen and other multi parameter monitoring,low flow oxygen inhalation in6hours,24hours of prophylactic use ofantibiotics, and nerve function with neurotrophic drugs, hormone assistedrecovery.24-48hours of unplugged drainage tube. Pull out the drainagepipe to patients with low molecular weight heparin before. After5-7daysunder the protection of orthosis ambulation.12-14days afterdischarge.After discharge from hospital to the relevant departments to furtherchemotherapy andbiological therapy. Regular follow-up. The relief ofpain were observed preoperatively,postoperatively (1days,1monthsbefore the operation, after operation6months); preoperative,postoperativeFranke1score of neurological symptoms (1days, before and after6months);degree of spinal function to improve the preoperative,postoperative (1days,1months before the operation, after operation6months); postoperative vertebral lesions in situ recurrence (1months afteroperation,6months after operation); spinal stability after operation (1months after operation,6months after operation).Result:1VAS from preoperative8.26±0.78to1days after operation,5.05±0.76,1months after surgery,2.79±0.52,6months after surgery,2.95±0.69. 2Cobb angle from preoperative22.05±1.79to1months after surgery,8.84±1.78,6months after surgery,9.53±1.70.3ADL score from preoperative4.45±0.51to1months after surgery,1.30±0.47,6months after surgery,1.30±0.47.419cases,2cases of Grade A had no obvious recovery, the other1casesrecovered to C grade, B grade5cases there were2cases of recovery isnot ideal,3patients recovered to grade D,7cases of grade C neuralsymptom improvement, to D level or slightly, D level and E level weresignificantly improved in4cases.5After1months,6months after the treatment, vertebral CT, see vertebrahad no bone destruction, soft tissue mass formed in situ recurrence.Conclusion: For thoracolumbar metastatic tumor patients, thesurgical operation treatment can getideal effect, improvements ofneurological function after operation and high rate of pain relief, a lowincidence of complications, improve the quality of life.