Background

The incidence of subaxial spinal metastases increases due to longer life expectancy resulting from successful modern cancer treatments. The three most utilized approaches for surgical treatment include the anterior, posterior, and combined approaches. However, despite increasing surgical volume, data on the postoperative complication profiles of different operative approaches for this patient population is scarce.

Methods

The institutional databases of two large referral centers in Thailand were retrospectively reviewed. Patients with subaxial cervical spine metastasis who underwent cervical surgery during 2005 to 2015 were identified and enrolled. Clinical presentations, baseline characteristics, operative approach, perioperative complications, and postoperative outcomes, including pain, neurological recovery, and survival, were compared among the three surgical approaches.

Results

The 70 patients (44 with anterior approach, 14 with posterior approach, 12 with combined approach) were enrolled. There were no statistically significant differences in preoperative characteristics, including Charlson Comorbidity Index (CCI), Tomita score, and Revised Tokuhashi score, among the three groups. There were no significant differences among groups for medical complications, surgical complications, neurological recovery, verbal pain score improvement, survival time, or ambulatory status improvement. However, the combined approach did show a significantly higher rate of overall perioperative complications (p = 0.01), intraoperative blood loss (p < 0.001), and operative time (p < 0.001) compared to the other two approaches.

Conclusions

Patients in the combined approach group had the highest rates of perioperative complications. However, although the differences were not statistically significant, patients in the combined group tended to have better clinical outcomes after follow-up and the longest survival time.

中文翻译：

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颈椎下轴转移的术后结果：前路、后路和联合入路的比较

背景

由于成功的现代癌症治疗延长了预期寿命，导致轴下脊柱转移瘤的发生率增加。三种最常用的手术治疗方法包括前路、后路和联合方法。然而，尽管手术量不断增加，但有关该患者群体不同手术方法的术后并发症特征的数据却很少。

方法

对泰国两个大型转诊中心的机构数据库进行了回顾性审查。确定并入组了 2005 年至 2015 年间接受颈椎手术的颈椎下段转移患者。比较三种手术方法的临床表现、基线特征、手术方法、围手术期并发症和术后结果，包括疼痛、神经功能恢复和生存率。

结果

70 例患者（前路入路44 例，后路入路14 例，联合入路12 例）入组。三组术前特征，包括 Charlson 合并症指数 (CCI)、Tomita 评分和修订的 Tokuhashi 评分，没有统计学上的显着差异。在医疗并发症、手术并发症、神经功能恢复、言语疼痛评分改善、生存时间或行走状态改善方面，各组之间没有显着差异。 然而，与其他两种方法相比，联合方法确实显示出总体围手术期并发症 ( p  = 0.01)、术中失血量 ( p  < 0.001) 和手术时间 ( p < 0.001) 的发生率明显更高。

结论

联合治疗组的患者围手术期并发症发生率最高。然而，虽然差异无统计学意义，但联合组患者在随访后往往有更好的临床结果和最长的生存时间。