METHODS: The authors present a case of a 68-year-old male with intractable lower-back pain and substantially diminished ambulation. Diagnostic imaging revealed a lumbar metastasis from a cholangiocarcinoma primary at L2-3 (4.5 cm anteroposterior × 5.7 cm transverse × 7.0 cm craniocaudal). The patient underwent a 2-level vertebrectomy with expandable cage placement and T10 to S2 fusion via a posterior-only approach. The patient regained much of his mobility and quality of life after the surgery.
CONCLUSIONS: Although this was a high-risk surgery, the authors show that a posterior-only approach can be used for lumbar vertebrectomies and fusion when necessary. Palliative surgeries carrying a high risk, especially in the setting of a limited prognosis, should include multidisciplinary deliberations and a thorough discussion of the risks and outcome expectations with the patient.
方法:作者介绍了一例68岁男性,患有顽固性下背痛,下床活动明显减少。诊断成像显示,原发性胆管癌在L2-3(前后4.5cm×5.7cm横向×7.0cm颅尾)有腰椎转移。患者接受了2级椎体切除术,并通过仅后路的方法进行了可扩张的笼子放置和T10至S2融合。手术后,患者恢复了大部分活动能力和生活质量。
结论:虽然这是一个高风险的手术,作者表明,仅后路入路可用于腰椎切除术和必要时的融合。姑息性手术风险很高,尤其是在预后有限的情况下,应包括多学科的审议,并与患者彻底讨论风险和结果预期。