Curative Effect Of Hybrid Separation Operation In Treating Spinal Metastases From Non-small Cell Lung Cancer Associated With Epidural Spinal Cord Compression

Background:Spinal metastases universally appeared in advanced non-small cell lung cancer(NSCLC).It could cause vertebral damage quickly,lead to epidural spinal cord compression(ESCC)and finally damage patient's nerve and motor function.It also give patients severe pain,Paralyzed limb,pathological fracture,and greatly affect their survival quality.Actually the patients' survival time is short,and the tumor is not sensitive to radiation or chemotherapy.Traditional surgical treatment is given priority to simple decompression surgery,and the prognosis is poor.In recent years,molecular targeted therapy,systemic stereotactic radiotherapy has greatly extended the survival time of such patients.Thus,how to improve the quality of life,and how to avoid nerve and motor dysfunction causing by metastatic spinal cord compression,has finally become the new proposition of surgical research.Objective:To study the curative effect of Hybrid separation operation in treating spinal metastases from non-small cell lung cancer associated with epidural spinal cord compression,and particularly the effect on the nerve,motor function,pain and patients' quality of life.Methods:48 cases admitted in our hospital during the same period with metastatic spinal cord compression from non-small cell lung cancer were divided into three groups.13 cases of HSS group were treated by HSS associated with conservative treatment.15 cases of simple decompression surgery group were treated by simple decompression surgery and the same conservative treatment.The remaining 20 cases were treated by conservative treatment.There was no significant difference in the demographic data,disease,nervous and movement function of the three groups(P > 0.05).Pain visual analogue scale(VAS),Frankel nerve function score,Karnofsky performance score,SF-36 life quality scale were taken into evaluation before and after the therapies among the three groups.Results:1 week after surgery,the muscle strength of lower limb of all patients in HSS group,recovered to level III plus.Meanwhile the 3-month postoperative VAS,Frankel nerve function score,Karnofsky performance score,SF-36 life quality scale results of HSS group were significantly better than the other two groups(P < 0.05).The VAS of simple decompression surgical group were improved a week after surgery(P < 0.05),however there was no significant difference of VAS after 3 months(P > 0.05).There were no significant deviations of the parameters in SF-36 quality of life scale(P > 0.05),except RF,RE,MCS(P < 0.05).But the parameters of BP,GH,SF,RE,MCS of simple decompression surgical group were better than the conservative treatment group(P < 0.05).The parameters of PF,BP,VT,GH,SF,RE,RCS,MCS in SF-36 quality of life scale were worse than pretreatment in the conservative treatment group(P < 0.05).Conclusion:It could not effectively improve patients' long-term survival life quality of metastatic spinal cord compression from non-small cell lung cancer by simple decompression surgery or conservative treatment.Recurrent oppression quickly appeared and it seriously affect the prognosis.HSS could effectively curb the further development of intra-spinal canal tumor,to improve the tumor pain,nerve and motor function and quality of life in patients with metastatic spinal cord compression.The clinical effect is considerable and worthy worth further clinical promotion.