BACKGROUND The benefits of surgery for symptomatic spinal metastases have been demonstrated, largely based on series of patients undergoing debulking and instrumentation operations. However, as cancer treatments improve and overall survival lengths increase, the incidence of recurrent spinal cord compression after debulking may increase. The aim of the current paper is to document the postoperative evolution of neurological function, pain, and quality of life following debulking and instrumentation in the Global Spine Tumor Study Group (GSTSG) database. METHODS The GSTSG database is a prospective multicenter data repository of consecutive patients that underwent surgery for a symptomatic spinal metastasis. For the present analysis, patients were selected from the database that underwent decompressive debulking surgery with instrumentation. Preoperative tumor type, Tomita and Tokuhashi scores, EQ-5D, Frankel, Karnofsky, and postoperative complications, survival, EQ-5D, Frankel, Karnofsky, and pain numeric rating scores (NRS) at 3, 6, 12, and 24 months were analyzed. RESULTS A total of 914 patients underwent decompressive debulking surgery with instrumentation and had documented follow-up until death or until 2 years post surgery. Median preoperative Karnofsky performance index was 70. A total of 656 patients (71.8%) had visceral metastases and 490 (53.6%) had extraspinal bone metastases. Tomita scores were evenly distributed above (49.1%) and below or equal to 5 (50.9%), and Tokuhashi scores almost evenly distributed below or equal to 8 (46.3%) and above 8 (53.7%). Overall, 12-month survival after surgery was 56.3%. The surgery resulted in EQ-5D health status improvement and NRS pain reduction that was maintained throughout follow-up. Frankel scores improved at first follow-up in 25.0% of patients, but by 12 months neurological deterioration was observed in 18.8%. CONCLUSION We found that palliative debulking and instrumentation surgeries were performed throughout all Tomita and Tokuhashi categories. These surgeries reduced pain scores and improved quality of life up to 2 years after surgery. After initial improvement, a proportion of patients experienced neurological deterioration by 1 year, but the majority of patients remained stable.

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对有症状的脊柱转移瘤进行器械减瘤手术的效果如何？它们能维持多久？全球脊柱肿瘤研究组数据库中的亚组分析。

背景技术已经证明了手术对有症状的脊柱转移瘤的益处，主要基于经历减瘤和器械手术的一系列患者。然而，随着癌症治疗的改善和总生存期的增加，减瘤后复发性脊髓压迫的发生率可能会增加。本论文的目的是在全球脊柱肿瘤研究组 (GSTSG) 数据库中记录减瘤和器械治疗后神经功能、疼痛和生活质量的术后演变。方法 GSTSG 数据库是一个前瞻性的多中心数据存储库，其中包含因有症状的脊柱转移而接受手术的连续患者。对于目前的分析，从数据库中选择了使用器械进行减压减瘤手术的患者。术前肿瘤类型、Tomita 和 Tokuhashi 评分、EQ-5D、Frankel、Karnofsky 以及术后并发症、生存率、EQ-5D、Frankel、Karnofsky 和第 3、6、12 和 24 个月的疼痛数字评分 (NRS) 分别是分析了。结果 共有 914 名患者接受了器械减压减瘤手术，并记录了直至死亡或手术后 2 年的随访。术前卡诺夫斯基表现指数中位数为 70。共有 656 名患者 (71.8%) 有内脏转移，490 名 (53.6%) 有椎外骨转移。富田分数平均分布在 5 分以上（49.1%）和 5 分以下（50.9%），德桥分数几乎平均分布在 8 分以下（46.3%）和 8 分以上（53.7%）。总体而言，手术后 12 个月的生存率为 56.3%。手术导致 EQ-5D 健康状况改善和 NRS 疼痛减轻，并在整个随访期间保持不变。25.0% 的患者在首次随访时 Frankel 评分有所改善，但在 12 个月时观察到 18.8% 的患者出现神经功能恶化。结论 我们发现在所有 Tomita 和 Tokuhashi 类别中都进行了姑息性减瘤手术和器械手术。这些手术减少了疼痛评分并提高了手术后长达 2 年的生活质量。在初步改善后，一部分患者在 1 年内出现神经功能恶化，但大多数患者保持稳定。结论 我们发现在所有 Tomita 和 Tokuhashi 类别中都进行了姑息性减瘤手术和器械手术。这些手术减少了疼痛评分并提高了手术后长达 2 年的生活质量。在初步改善后，一部分患者在 1 年内出现神经功能恶化，但大多数患者保持稳定。结论 我们发现在所有 Tomita 和 Tokuhashi 类别中都进行了姑息性减瘤手术和器械手术。这些手术减少了疼痛评分并提高了手术后长达 2 年的生活质量。在初步改善后，一部分患者在 1 年内出现神经功能恶化，但大多数患者保持稳定。