背景:在过去的几年中,激光间质热疗法(LITT)也已开始用于神经外科手术。其对颅内病变的疗效,即,肿瘤和癫痫,已被广泛证明。然而,关于使用LITT治疗脊柱病变的文献证据是最近的,它仍然是关于其功效的讨论话题。这里,作者试图对研究LITT在脊柱病变中的应用的文献进行系统回顾.
方法:使用PubMed,Scopus,还有Cochrane图书馆,作者对有关脊柱激光间质热疗法(sLITT)使用的文献进行了系统综述.搜索中包括随机对照试验,队列研究,和临床系列。两名独立审核员进行了研究评估,数据抽象,和研究的质量评估。
结果:在最初的134项研究中,6符合系统评价的纳入标准,共206名患者。所有患者均已接受sLITT治疗压迫性脊柱转移瘤。大多数病变为胸部(88.8%)。所有研究都报道了有效的局部控制疾病,并在30天时减少了硬膜外压迫。并发症发生率为12.6%,但大多数都是瞬态条件,只有3.4%的患者需要进行翻修手术.
结论:sLITT是安全的,可以有效地局部控制转移瘤的硬膜外压迫,尤其是胸椎。作者建议在选定的脊柱转移患者中考虑将sLITT作为开放手术的替代方法。
BACKGROUND: In the last years, laser interstitial thermal therapy (LITT) has started to be used also in neurosurgical setting. Its efficacy for intracranial pathologies, namely, tumors and epilepsy, has been widely demonstrated. However, the literature evidences about the use of LITT for spinal lesions are recent, and it is still a topic of discussion regarding its efficacy. Here, the authors sought to present a systematic
review of the literature investigating the utility of LITT for spinal lesions.
METHODS: Using PubMed, Scopus, and the Cochrane Library, the authors performed a systematic
review of the literature focused on the use of spinal laser interstitial thermal therapy (sLITT). Included in the search were randomized controlled trials, cohort studies, and clinical series. Two independent reviewers conducted the study appraisal, data abstraction, and quality assessments of the studies.
RESULTS: Out of the initial 134 studies, 6 met the inclusion criteria for the systematic
review, resulting in a total of 206 patients. All the patients have been treated with sLITT for compressive spinal metastases. Most of the lesions were thoracic (88.8%). All the studies reported an effective local control of the disease with a reduction of epidural compression at 30 days. Complication rate was 12.6%, but most of them were transient conditions, and only 3.4% patients needed a revision surgery.
CONCLUSIONS: sLITT is safe and provides effective local control for epidural compression from metastases, particularly in the thoracic spine. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.