Clinical efficacy of vertebral "Collapse" lesion resection surgery for treating thoracolumbar spinal metastases

English Keywords:Spinal metastases  Separation surgery  Surgical treatment  Vertebral "Collapse" resection  Microwave

English Abstract:

  【Abstract】 Objectives: To explore the clinical efficacy and the postoperative recurrence rate of the vertebral "Collapse" lesion resection for treating thoracolumbar spinal metastases compared to separation surgery. Methods: A retrospective study was conducted on 78 patients with thoracolumbar spinal metastases treated at Tianjin University General Hospital from December 2018 to December 2022. There were 42 males(53.8%) and 36 females(46.2%), with a mean age of 61.9±10.6 years(range 34-76 years). The patients were divided into separation surgery group(21 cases) and "Collapse" resection group(57 cases). Two to three weeks after surgery, radiotherapy, chemotherapy or targeted drugs were given according to the type of primary tumor after wound healing. The data on operative time, intraoperative blood loss, drainage volume, Frankel classification for spinal cord injury, and visual analogue scale(VAS) scores for pain preoperatively, 7d after operation and at final follow-up, as well as local recurrence rates and perioperative complications were collected. Results: The operative time and intraoperative blood loss in the "Collapse" resection group(328.7±89.2min, 782.5±89.2mL) were significantly higher than those in the separation surgery group(243.2±89.2min, 585.7±89.2mL)(P<0.05). There was no statistically significant difference in postoperative drainage volume between the two groups ("Collapse" resection group 698.2±230.2mL vs separation surgery group 674.7±180.7mL)(P>0.05). During follow-up, all the patients in the separation surgery group received stereotactic radiotherapy postoperatively; While 10 patients(21.2%) in the "Collapse" resection group underwent radiotherapy, and the remaining 47(78.8％) patients received targeted, immunological, or chemotherapy as part of comprehensive treatment. The recurrence rate in the separation surgery group was approximately 9.5%(2/21). Among the patients who received "Collapse" resection plus radiotherapy, there was 1 local recurrence, resulting in a recurrence rate of 10%(1/10), while the patients who didn′t receive radiotherapy experienced 3 local recurrences, with a recurrence rate of 6.4%(3/47). The overall recurrence rate for patients in the "Collapse" resection group was 7.0%(4/57). There was no statistically significant difference in recurrence rates between the two surgical procedures(P=0.708). In the separation surgery group, postoperative complications included one case of wound infection, one case of wound dehiscence two months after postoperative radiotherapy, and one case of epidural hematoma causing compression. In the group of "Collapse" resection, complications included one case of cerebrospinal fluid leakage with secondary infection and one case of superficial wound infection. VAS scores on 7d postoperatively significantly decreased compared to preoperative scores in both groups(P<0.05), and there were significant differences in VAS scores at final follow-up compared to preoperative scores(P<0.05). No statistical difference in VAS scores was observed between the two groups on 7d postoperatively and at final follow-up(P>0.05). Except for 5 Frankel A-D grade patients with no significant improvement in neurological function, the remaining 73 patients showed no deterioration in neurological function, with varying degrees of recovery of at least 1 grade, yielding an improvement rate of 93.6%(73/78). Conclusions: The vertebral "Collapse" resection for thoracolumbar spinal tumors does not require postoperative radiotherapy, as the tumor recurrence rate is comparable to that of patients treated with separation surgery followed by radiotherapy.