PDF(Pubmed)
Abstract：
BACKGROUND: Spinal metastases are commonly seen in patients with cancer and often indicate a poor prognosis. Treatment can include curative or palliative surgery, chemotherapy, and radiation therapy. The surgical approach varies widely on the basis of the affected region of the spine, the location of the tumor (anterior versus posterior), the goal of surgery, the health of the patient, and surgeon preference.
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.
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.
摘要：
背景：脊柱转移常见于癌症患者，通常表明预后不良。治疗可以包括治愈性或姑息性手术，化疗,和放射治疗。手术入路根据脊柱的受影响区域差异很大，肿瘤的位置（前与后），手术的目标，病人的健康,和外科医生的偏好。
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。
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。
