Background: Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. Methods: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. Results: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p< 0.001) for occurrence of SCS during follow-up. Conclusion: Surgical treatment of spinal metastatic disease improves patients’ quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.
背景：对于伴有硬膜外脊髓压迫（ESCC）的脊柱转移性疾病患者，手术减压（SD）联合或不联合后路稳定术并辅以放疗是一种成熟治疗方案。本研究旨在明确局部复发导致神经功能损害的风险因素。方法：纳入2011年至2022年间在本中心接受脊柱转移性疾病手术治疗的所有患者。评估指标包括肿瘤实体类型、减压手术技术（减压术、半椎板切除术、椎板切除术、椎体切除术）、神经功能缺损程度、ESCC分级、放疗间隔时间及围手术期并发症。结果：最终分析共纳入747例患者，中位随访时间296.8天（95% CI (263.5, 330.1)）。随访期间7.5%的患者出现脊髓/马尾综合征（SCS）。多变量分析显示放疗延迟（>35天）是随访期间发生SCS的独立风险因素（p<0.001）。结论：脊柱转移性疾病的手术治疗可改善患者生活质量和Frankel分级，但需在数周内安排放疗以降低肿瘤所致神经功能损害风险。
肿瘤(癌症)患者之家