Vergleich zwischen operativen und nicht-operativen Verfahren bei Wirbelsäulenmetastasen: Eine retrospektive Studie an 259 Patienten

Zusammenfassung

Studienziel: Ziel dieser klinischen Studie war ein Vergleich zwischen operativen und konservativen Therapieoptionen bei Wirbelsäulenmetastasen. Methode: Hierzu wurden retrospektiv 259 Patienten mit metastatischen Tumoren der Wirbelsäule analysiert. Die evaluierten Parameter umfassten demographische Daten, Primärtumor, die Tumorlokalisation innerhalb der Wirbelsäule, operatives beziehungsweise konservatives Therapieregime, zusätzliche adjuvante systemische Therapie und das postoperative Outcome mit neurologischem Status. Ergebnisse: Die am häufigsten gestellte Indikation für ein operatives Vorgehen war eine Kombination zwischen neurologischen Ausfällen, pathologischer Wirbelkörperfraktur und Schmerzen (50 %). 69 % der Patienten wurden von dorsal operiert, 13 % über einen ventralen Zugang und 10 % über einen ventro-dorsalen Zugang. Das postoperative Resultat zeigte eine Verbesserung der neurologischen Symptomatik bei dorsalem Zugang in 29 % der Fälle, in 53 % bei ventralem Zugang, und in 15 % bei ventro-dorsalem Zugang. Diskussion: Diese Untersuchung zeigt, dass bei der Indikationsstellung zur Operation die exakte Lokalisation der Metastase innerhalb der Wirbelsäule, die klinischen Symptome und die Prognose der zugrunde liegenden Krankheit genau berücksichtigt werden müssen. Eine regelhafte Korrelation zwischen operativem Zugang und Verbesserung der neurologischen Situation lässt sich durch die vorgelegten Daten nicht belegen.

Abstract

Aim: The purpose of this study was to evaluate the clinical outcome of patients with metastatic tumors of the spine after surgical and non-surgical treatment. Methods: The charts of 259 patients with metastatic tumors of the spine were reviewed retrospectively to define predictors of outcome. Our data included patient demographics, primary tumor, location of the metastatic tumor within the spine, indication for surgical or non-surgical treatment, type of surgical and non-surgical intervention, post-treatment outcome in terms of neurology, use of adjuvant radiation therapy or systemic therapy. Results: The most frequent indication for surgical treatment was the combination of neurological deficit (ND), pathological vertebral fracture, and pain (50 %). Surgical intervention was performed by the posterior approach in 67 %, by the anterior approach in 13 %, and by an anterior/posterior approach in 10 %. The post-surgical outcome, depending on the type of surgical approach in terms of ND, was for the posterior approach 29 % improved, for the anterior approach 53 % improved, and for the anterior/posterior approach 15 % improved. Discussion: Our data suggest that the indications for metastatic tumor surgery in the spine depend on the location of the metastatic tumor in the spine, clinical symptoms, and prognosis.

Schlüsselwörter

Wirbelsäulenmetastasen - neurologische Ausfälle - operative und nicht-operative Verfahren

Key words

Metastatic tumors of the spine - neurological deficit - surgical approach

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