Surgical treatment of spinal thoracic metastases with nerve injury in patients with moderate-to-severe spinal cord injury.

Abstract

Among spine metastases of malignant tumors, thoracic spine metastases account for about 70%. Spinal metastases cause spinal instability, compression of nerve structures, and function damage, which has a serious impact on patients' quality of life (QOL). At present, surgery is main choice in the treatment of spinal metastases. However, conventional surgery still has certain limitations. This study explored the surgical strategy of nerve rescue in patients with spinal thoracic metastases and moderate-to-severe spinal cord injury. In this history case-control study, 42 patients received conventional operation were enrolled as control group, while 38 patients who underwent conventional decompression of laminectomy combined with durotomy were selected as observation group. Perioperative data were recorded for comparisons between the two groups. Visual analogue scale (VAS) of pain, QOL, and 36-item short-form health survey (SF-36) were compared before operation and 3, 6, and 12 months after operation. American Spinal Injury Association (ASIA) grade was evaluated before operation and 1 month after. Complications, recurrence rate, and mortality were also recorded. The VAS scores of the observation group at 3, 6, and 12 months after operation were significantly lower than those before the operation. The QOL and SF-36 scores were increased compared with those taken preoperatively (P<0.05). The VAS score of the observation group was lower than that of the control group, and the QOL and SF-36 scores were higher than those in the control group (P<0.05). The neurological grades of ASIA 3 months after operation in both groups were significantly improved. The improvement in the observation group was greater than that in the control group (P<0.05). The incidences of postoperative complications in the control group and observation group were 19.05% (8/42) and 7.89% (3/38), respectively; the recurrence rates of the two groups were 14.29% (6/42) and 5.26% (2/38), respectively; and the mortality rates of the two groups were 26.19% (11/42) and 18.42%, respectively (7/38) (P>0.05). Durotomy based on conventional decompression of laminectomy can effectively save nerve function in metastases of the thoracic spine with moderate or severe spinal cord injury, improve QOL, and is thus worthy of being applied in clinic.