Comparative analysis of the clinical outcomes of total spondylectomy and subtotal spondylectomy in treating spinal metastases

English Keywords:Metastatic carcinoma of spine  Total spondylectomy/subtotal spondylectomy  Postoperative effect  Survival time

English Abstract:

  【Abstract】 Objectives: To compare and analyze the clinical efficacies of total spinal resection and subtotal spinal resection for the treatment of spinal metastases. Methods: The data of 43 patients with spinal metastases who underwent surgical treatment in our hospital from May 2004 to February 2017 were retrospectively analyzed. According to the surgical method, the patients were divided into two groups: total spinal resection group(14 cases) and subtotal spinal resection group(29 cases). There were no significant differences in gender, age, nature of primary tumor, type of lesion and other general data between the two groups(P>0.05). Karnofsky performance scale(KPS) score, visual analogue scale(VAS) score and Frankel grading were used to evaluate the functional status, pain degree and neurological function of the patients before operation and 1 month after operation. The postoperative survival of patients were followed up, and Kaplan-Meier curves were drawn and compared using the Log-rank test. Results: The preoperative VAS scores were 5.29±1.54 and 5.00±1.58 in total and subtotal spinal resection groups, respectively, and preoperative KPS scores were 70.71±8.29 and 69.31±11.00, respectively. Postoperative 1 month VAS scores were 1.00±1.52 and 0.97±1.88, respectively, and KPS scores were 85.00±7.60 and 85.17±17.45, respectively. The VAS and KPS scores of both groups significantly improved compared with those before operation, and the differences were statistically significant(P<0.001), while there was no statistical difference between the two groups respectively(P>0.05). The Frankel grades of patients of both groups after operation significantly improved compared with those before operation, and the differences were statistically significant(P<0.001), while there was no significant difference between the two groups(P>0.05). Postoperative recurrence occurred in 6 cases, including 1 case in total spinal resection group and 5 cases in subtotal spinal resection group, and the difference was statistically significant(χ2=6.416, P=0.011). Survival analysis showed that the median survival time of patients in the total spinal resection group was 10.0 months(95%CI: 0.29-19.71), which in subtotal spinal resection group was 11.0 months(95%CI: 4.60-17.40). The half a year cumulative survival rates of patients in total spinal resection group and subtotal spinal resection group were 63.6% and 63.2%, respectively, and the 1-year survival rates were 45.2% and 42.1%, respectively, with no statistical differences between groups(P>0.05). Conclusions: Both total and subtotal spinal resection can significantly improve the functional status, pain degree and neurological function of patients with spinal metastases, and total spinal resection is helpful to reduce local recurrence of spinal metastatic tumor after operation.