| Purpose: With the increasing morbidity of malignant tumors,spinal metastatic tumors have been showing a gradually increasing trend.Spinal metastatic tumors impact living quality of most patients through disrupting the normal anatomical structures of the spine resulting in spinal instability,nerve compression and inducing severe spinal pain and severe nerve dysfunction.At present,the multidisciplinary combination therapy has become the trend of spinal metastatic carcinoma treatment.However,surgical treatment which displays an important significance of removing symptoms,reconstruction of spinal stability,relieving nerve compression,and improving the quality of life is still the primary therapy.This study was aimed to evaluate the clinical effects of the surgical management with piecemeal total resection(PTR)and double titanium cage reconstruction on patients of lower lumbar spinal metastases with short expected lifetime(less than 1 year)and poor prognosis.Methods: According to the inclusion and exclusion criteria,we prospectively selected11 patients with lumbar spinal metastases of our hospital from January 2014 to January 2016.The selected patients included 6 male and 5 female patients and the mean age was 63.7±10.7 years(range from 46 to 78 years).Patients received preoperative assessment in four aspects of systemic tumor condition,general living conditions,lumbar metastatic lesion and the prognosis.The assessment methods are as follow:1.Assessment of systemic tumor condition: biopsy of local lesion for clearing the nature of the tumor and emission computed tomography(ECT)for multi areas;2.Assessment of general living conditions: Karnofsky scoring(KPS)was adopted to evaluate the patients' general living conditions and the injury classification of American spinal injury association(ASIA)was used to assess the neurological function;3.Assessment of lumbar metastatic lesion: The degree and scope of vertebral body involvement,accessory involvement,spinal canal involvement and the compression degree of cauda equina were preoperativly measured by MRI,CT and X-rays;4.Assessment of prognosis: Tokuhashi revised scoring system and Tomita scoring system were conjunctively used for assessing the prognosis and guiding treatment.All patients underwent a PTR via a single posterior approach and double titanium cage reconstruction meanwhile adjuvant chemoradiotherapy was performed to prevent systemic and local tumors after surgery.VAS score,ASIA impairment scale,status of tumor relapse and the success of internal fixation were analyzed to assess the clinical effects and security of our surgical method.Results: All 11 patients underwent PRT via a single posterior approach and double titanium cage reconstruction successfully and none of them suffered iatrogenic complications such as dural injury.The mean operation time was 5.7 ± 0.8 h(range from4.5 to 7 hours),with an average blood loss of 2,100 ± 630 ml(range from 1000 to 3200 ml).Local pain or radicular leg pain was relieved for all patients postoperatively and VAS scoring was significantly improved,especially 1 month after operation.Significant improvements in neurological function were achieved in 9patients(81.8%),while 2 patients received a preoperative ASIA impairment scale.Follow-up time lasted 5 to 16 months(Mean=10 months)during which three patients died of the disease and one patient suffered local recurrence.No major complications,instrumentation failure at the final follow-up.Conclusions: The piecemeal total resection and double titanium cage reconstruction via a single posterior approach is feasible,safe and effective for special selected cases with poor-prognosis lumbar spinal metastases and less than 1 year of survival. |
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