Posterior microscope-assisted dural resection combined with spinal internal fixation in the treatment of single-center intradural spinal cord metastases

English Keywords:Intradural spinal cord metastases  Surgery  Intramedullary spinal cord metastases  Microsurgery

English Abstract:

  【Abstract】 Objectives: To investigate the effects of posterior microscope-assisted dural resection combined with spinal internal fixation in the treatment of single-center intradural spinal cord metastases(ISCM). Methods: Retrospective analysis was conducted in 10 patients with ISCM treated with surgery from orthopedic department of the Fourth Hospital of Hebei Medical University from January 2011 to January 2016. There were 10 patients in this cohort, including 6 males and 4 females, aged from 44 to 63 years. The median age was 55 years. Primary tumors included 3 lung cancer, 3 breast cancer, 2 kidney cancer, 1 tongue cancer and 1 esophageal cancer. The tumor was located in the cervical spinal canal in 1 case, 4 cases of thoracic canal, 2 cases of thoracolumbar canal, 3 cases of lumbar spinal cord, 8 cases of extramedullary metastases, 2 cases of intramedullary metastases. The data included operation time, intraoperative blood loss, complications and survival time. The visual analogue scale(VAS), McCormick score and KPS score were used to evaluate the pain, neurological function and survival status of the patients before and after operation. Results: The operation time was 130-260min(180±25.4min), the intraoperative blood loss was 400-2100ml(1050±350.4ml), and the median survival time was 10-19 months(median survival time was 11 months). All patients had significantly relieved postoperative pain, the VAS pain score at 1 month after operation decreased from 6.70±0.67 points to 1.70±0.67 points(P<0.05). The KPS score significantly improved from preoperative 42.00±4.21 points to 69.00±7.37 points at 3 months after operation(P<0.05). 9 cases had significantly improved McCormick score at 3 months after operation compared with preoperation. 1 case of grade 3 had no significant improvement after surgery, and there was no postoperative neurological symptom deteriorated case. As for postoperative complications, one was the cerebrospinal fluid leakage, the other was the hematoma. Both of them were the intramedullary metastases. Conclusions: Posterior microscope-assisted dural resection combined with spinal internal fixation can improve the life quality of patients with intradural spinal cord metastases, whereas caution is advised for intramedullary lesions.