Shifting Paradigms in the Treatment of Metastatic Spine Disease

被引:116
作者
Bilsky, Mark H. [1 ,2 ]
Laufer, Ilya [1 ,2 ]
Burch, Shane [3 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Neurol Surg, New York, NY 10065 USA
[2] Weill Cornell Med Coll, Dept Neurol Surg, New York, NY USA
[3] Univ Calif San Francisco, Dept Orthoped Surg, San Francisco, CA 94143 USA
关键词
metastatic spine disease; epidural spinal cord compression; radiation therapy; stereotactic; radiosurgery spine surgery; renal cell carcinoma; en bloc resection; EN-BLOC SPONDYLECTOMY; VERTEBRAL BODY RESECTION; RENAL-CELL CARCINOMA; CORD COMPRESSION; THORACOLUMBAR SPINE; ANTERIOR DECOMPRESSION; SURGICAL-MANAGEMENT; RADIATION-THERAPY; MALIGNANT-TUMORS; BONE-TUMORS;
D O I
10.1097/BRS.0b013e3181bac4b2
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. Systematic review and evidence appraisal. Objective. To evaluate the optimal treatment for patients with spinal cord compression secondary to solid metastases and in patients with solitary renal metastases, without spinal cord compression. Methods. Focused Medline and OVID database searches were conducted using relevant keywords. Only clinical articles that evaluated specific end points of interest were included in the literature review. The quality of evidence provided by each article was assessed using the ATS guidelines. The expert opinion was synthesized based on the evidence and rated as strong or weak, depending on the quality of the supporting literature. Results. Twelve surgical and 7 radiation clinical series were identified that evaluated post-treatment ambulation in patients with metastatic spinal cord compression. Only 1 surgical article met the criteria for moderate quality evidence while the remaining surgical and radiation articles presented very low quality of evidence. All articles that evaluated treatment of solitary renal metastases presented very low quality of evidence. Conclusion. A strong recommendation is made for patients with high-grade cord compression due to solid tumor metastases to undergo surgical decompression with stabilization followed by radiation therapy. A weak recommendation is made for patients with solitary renal metastases without spinal cord compression to undergo spinal stereotactic radiosurgery.
引用
收藏
页码:S101 / S107
页数:7
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