目的:作为脊柱转移瘤的重要治疗手段,手术有严格的适用条件。尽管各种组织都制定了不同的脊柱转移瘤(SM)手术治疗指南,内容有一定的差异,准则的标准化和质量,有必要对其进行批判性评估。我们旨在系统回顾和评价当前关于SM外科治疗的指南,并通过支持证据的质量评估总结相关建议。为手术治疗方案的规范化提供参考,帮助临床一线医务工作者更快地做出安全有效的临床决策。
方法:我们搜索了Pubmed,WebofScience,和Embase三个主要数据库和在线指南数据库。根据某些纳入和排除标准,整理了最新的SM手术治疗指南.AGREEII用于评估指南的质量,我们提取并比较了每个指南的推荐治疗内容,并通过证据分级量表进行评估。
结果:包括2013年至2019年的八项指南。七个指南是综合指南,一个与SM的重建手术有关。五项准则被评估为“建议”,“和三个指南被评估为“建议”,并进行了修改。“关于SM手术的适应症,四条准则,七个准则,七个准则,三项指南和三项指南建议对患有顽固性疼痛的SM患者进行手术治疗,机械不稳定性,转移性硬膜外脊髓压迫(MESCC),复发性脊柱转移瘤(RSM),和生存预测,分别。关于手术策略,三项指南推荐了微创治疗,但有严格的适应证.六个指南和五个指南建议姑息性手术并接受放射治疗,分别。对于激进的手术,只有一项指南推荐适用于一般情况良好且有孤立症状的SM患者.关于手术重建,1个指南不推荐髂骨移植,3个指南推荐PMMA骨水泥.
结论:大多数指南没有提供明确的手术应用标准,而是提供了更多的基本框架。这些手术建议的证据水平从LOEB到D,几乎所有的指南都推荐椎体成形术和椎体后凸成形术,但是对于姑息性和更具侵略性的手术,建议通过多学科合作个性化特定的手术策略。
OBJECTIVE: As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster.
METHODS: We searched Pubmed, Web of Science, and Embase for three major databases and online
guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the
guideline\'s quality, and we extracted and compared the recommended treatment content of each
guideline with evaluating by the evidence-grading scale.
RESULTS: Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as \"recommended,\" and three guidelines were evaluated as \"recommended with modifications.\" Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one
guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one
guideline didn\'t recommend iliac bone graft and three
guidelines recommended PMMA bone cement.
CONCLUSIONS: Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.