Observation Of The Efficacy Of Separation Surgery Combined With SRS In The Treatment Of Thoracic And Lumbar Spinal Metastases

Objective To investigate the clinical effect of separation surgery combined with stereotactic radiation(SRS)in the treatment of thoracic and lumbar spinal metastases.Methods Retrospectively analysis the clinical data of 23 patients with spinal metastases treated with separation surgery combined with postoperative SRS and 14 patients with spinal metastases treated with total en bloc spondylectomy combined with postoperative SRS in the General Hospital of Ningxia Medical University from September 2013 to September 2018,including 18 cases of males and 19 cases of females.Age:32~72 years,the average age was 56.00±8.70 years.The primary tumors include 8 cases of lung cancer,6 cases of breast cancer,5 cases of thyroid cancer,4 cases of prostate cancer,6 cases of renal cancer and 8 cases of another tumor.The distribution of metastatic lesion in vertebral body was in thoracic spine in 21 cases,lumbar spine in 16 cases.The medical history,imaging data,operation time,intraoperative blood loss,postoperative complications and clinical efficacy of all patients were analyzed.The VAS score was used to evaluate the pain of patients,the Frankel score was used to evaluate the neurological function of patients,the KPS function score was used to evaluate the physical health status of patients.The patients were followed-up regularly by ways of telephone,outpatient,family visit and other means at 1,3,6,12,24 months after operation respectively.The postoperative situation of patients was evaluated by X-ray,CT,MRI,bone scans or PET-CT.The VAS score,Frankel score,KPS function score were used to evaluate the clinical efficacy of separation surgery.Results The patients in two groups were all followed up for more than 6 months.(1)The age,gender,site of lesion and sort of primary tumor of the patients in two groups were recorded and statistically analyzed,there was no statistically significant difference between two groups(P>0.05),which indicates that the general data of the patients in two groups were comparable.(2)The intraoperative blood loss and operation time of two groups were compared and analyzed by independent samples t test,the operation time of separation surgery group was 3h~4.5h,the average time was 3.46±0.48h;the operation time of total en bloc spondylectomy group was 5h~7h,the average time was 6.18±0.64 h,there was statistically significant differences between two groups,the t value is 14.83(P<0.01);The intraoperative blood loss of separation surgery group was 300-1500 ml,the average blood loss was 721.74±276.26 ml,the intraoperative blood loss of total en bloc spondylectomy group was 800-2500 ml,the average blood loss was 1521.43±527.96 ml,there was statistically significant differences between two groups,the t value is-5.247(P<0.01).(3)The VAS score: In the group comparison,VAS scores of patients in group A and B were compared respectivly,and the differences were statistically significant(P<0.01).The result suggested that the pain of patients in both groups was significantly relieved after treatment.There was no significant difference in VAS scores between groups A and B(P>0.05).(4)Frankel neurological function score: In the group comparison,Frankel scores of patients in group A and B were compared respectivly,and the differences were statistically significant(P<0.01).The result suggested that the neurological function was improved in both groups after treatment.There was no significant difference in Frankel scores between groups A and B(P>0.05).(5)KPS functional score: In the group comparison,KPS scores of patients in group A and B were compared respectivly,and the differences were statistically significant(P<0.01),The result suggested that the physical condition of patients in both groups was improved after treatment.There was no significant difference in KPS scores between groups A and B(P>0.05).Conclusion The separation surgery combined with SRS can achieve the same clinical efficacy as the total en bloc spondylectomy combined with SRS in the treatment of single spinal metastases,but it has the advantages of less intraoperative blood loss,short operation time and rapid recovery.The separation surgery can relieve the pain,alleviate the compression of spinal cord and achieve the goal of local control of tumor,which is a safe and effective method for the treatment of thoracic and lumbar spinal metastases.