Treatment Of Spinal Metastasis Of Lung Adenocarcinoma By Percutaneous Vertebroplasty And Open Surgery

ObJective: To explore the surgical indications,postoperative curative effect and surgical approach of percutaneous vertebroplasty(PVP)and open surgery for the treatment of spinal metastases of lung adenocarcinoma.Methods: 31 patients with spinal metastases of lung adenocarcinoma were divided into two groups according to the surgical method.14 patients with spinal cord or nerve root compression,or severe spinal instability were open surgery,including anterior vertebral resection of internal fixation in 3 cases,2 cases of total vertebral resection,palliative posterior tumor(partial)resection Decompression internal fixation in 9 cases.Four of the 14 patients underwent vertebroplasty.There were 6 cases of thoracic vertebrae,6 cases of lumbar spine and 2 cases of thoracolumbar spine.17 patients with no obvious spinal cord or nerve root compression,and the posterior margin of vertebral body was treated by percutaneous vertebroplasty.There were 17 thoracic vertebrae,27 lumbar spine,1 sacral vertebrae.The expected survival was assessed by the Tomita scoring system.The pain and spinal cord function were evaluated by VAS score and ASIA grading.The survival rate of the two groups was evaluated by Kaplan-Meier method,and the operation time of the two groups was recorded.Results:1 Preoperative prognostic assessmentTwo groups of patients` Tomita score≥6,and there was no significant difference between the two groups.2 Pain reliefThe pain in the open surgery group was significantly improved after 1 month,and the pain in the PVP group was significantly improved on the second day after operation.There was significant difference between the two groups in VAS score(P <0.0001).3 Operation time and blood transfusionIn the open surgery group,the median operative time was 260 min(210-330 min),the median blood transfusion was 520 ml(0 to 850 m1),and 13 patients required blood transfusion(85.7%).PVP surgery group without bleeding,the median operation time 65min(50-120min).4 Spinal cord function improvementIn the open surgery group,11 patients’ spinal cord dysfunction were improved,and ASIA scores were statistically significant(P <0.001).In the PVP group,3 cases’ ASIA scores were D,the rest were E,ASIA score after surgery compared with the preoperative difference was not statistically significant.5 Survival analysisDuring the follow-up period,there were 9 patients died and 5 patients survived in the open surgery group.The median survival time was 13 months(1 to 24 months).The 6-month survival rate was 71.4%,the 1-year survival rate was 57.1%.12 patients died and 5 patients survived in the PVP group.The median survival time was 9 months(1 to 24 months).The 6-month survival rate was 64.7% and the 1-year survival rate was 47.1%.There was no difference between the two groups(P>0.05).Conclusion:1 Lung adenocarcinoma patients with spinal metastasis of postoperative who can keep system related to medical treatment,survival mostly more than 3 months,and surgery can quickly relieve patients’ pain,improve nerve function,make the most of lung adenocarcinoma patients with spinal metastasis eventually benefited.2 There was no difference between the two groups’ survival,open surgery may not be able to effectively extend the survival of patients.Vertebroplasty operation`s time is short,and less bleeding,quick recovery after surgery.For no nerve compression symptoms or severe spinal instability of lung adenocarcinoma patients with spinal metastasis,vertebral plasty is the preferred treatment.3 Vertebroplasty can not effectively release the spinal cord、nerve root compression,postoperative neurological function improved less than open surgery.The patients with any of the following circumstances,may consider open surgery,if the general situation is better,preoperative assessment can tolerate open surgery: vertebral bone damage caused by serious instability(vertebral serious collapse of more than 70 %,Subluxation,severe kyphosis,combined with extensive or multi-segment small Joints and other accessories involved,etc.),spinal cord compression leading to paralysis or paralysis,severe nerve root pain.