Clinical outcomes of decompression and pedicle screw fixation combined with or without microwave ablation in the treatment of spinal metastases

English Keywords:Spinal metastases  Microwave ablation  Decompression and screw fixation  Pathological fractures

English Abstract:

  【Abstract】 Objectives: Clinical observation and comparison of microwave ablation combined with or without decompression and pedicle screw fixation in the palliative treatment of spinal metastases. Methods: From January 2017 to January 2020, 69 patients with spinal metastases and pathological fractures were treated in West China Hospital and the Fourth Sichuan Provincial People′s Hospital. 37 patients received pedicle screw fixation with laminectomy(group A), and 32 patients received microwave ablation combined with laminectomy and pedicle screw fixation(group B). The Tomita and Tokuhashi scores, preoperative neurological dysfunction time, operation time and intraoperative blood loss of all patients were recorded. The epidural spinal cord compression(ESCC) and spinal instability neoplastic score(SINS) scores were used to evaluate the degree of spinal compression and spinal instability. The Frankel grade of spinal nerve function, VAS pain score, and SF-36 quality of life score were recorded before and after operation. Kaplan-Meier method was used to evaluate the overall survival and progression free survival of all patients. Independent sample t-test was used to compare the two groups at the same time point, paired t-test was used to compare within group, and χ2 test was used to compare the rates of two groups. Results: All the 69 patients were followed up for 5 to 36 months with the median time of 18 and 20 months in two groups, respectively. There was no significant difference in preoperative Tomita scores, modified Tokuhashi scores, SINS scores and ESCC scores between the two groups. The intraoperative blood loss of group A was 567±137ml, which was lower than that of group B 690±90ml(P=0.02). The VAS score and SF-36 quality of life scores of the two groups were improved after operation. There was no difference between the two groups before and 24 hours after operation. The VAS scores of group A were 2.84±1.30 and 2.45±1.01 at 1 and 3 months after operation, and the SF-36 score of group A was 67.43±7.49 at 3 months after operation. The two scores of group A were better than those of group B (P<0.05). 89.2%(33 cases) patients in group A and 93.8%(30 cases) patients in group B improved in the postoperative spinal cord function. There was no significant difference between the two groups. There was no significant difference in the overall survival between the two groups, but the progression free survival in group B was better than that in group A(P=0.03). Conclusions: The microwave ablation combined with decompression and pedicle screw fixation does not significantly increase the surgical trauma and patient risk, and it has a certain comparative advantage and clinical application value in relieving pain, improving vertebral stability, improving patients′ quality of life in the treatment of spinal metastases.