| Objective:This article reviewed the patients with spinal metastases admitted to our department from January 2013 to August 2018,and analyzed the treatment strategies based on Tomita scores of 4～7.Methods:From January 2013 to August 2018,109 patients with spinal metastases were enrolled in our department.Tomita scores were performed:7 patients scored 2 to 3 points,93 patients scored 4 to 7 points,and 9patients Score 8 to 10 points.Patients with a score of 4 to 7 were grouped according to different treatment methods: 30 patients underwent open surgery,41 patients underwent PVP,and 22 patients underwent conservative treatment.The following data were retrieved from inpatient medical records,outpatient visits,and telephone follow-up records for visual analogue scale(VAS);Frankle classification;Karnofsky scale(KPS);operative time;bleeding volume;Complications;hospital stay.Resrlts:The follow-up data of all patients were complete.(1)The operation time of the open group was 196.35±112.97 min,the blood loss was 1096.43ml±911.03 ml,the hospitalization time was 29.0±14.8d,and the complications occurred in 8 patients(26.66%).The operation time of thePVP group was 53.88±13.75 min,and the blood loss was 12.33±.4.95 ml,hospitalization time was 7.04±2.84 d,10 cases(24.39%) patients had bone cement leakage but did not cause obvious symptoms.The operation time,blood loss and hospitalization time of PVP group were less than open group(P<0.05).(2)The pain,daily activity and neurological function were improved in the open group after surgery.The VAS score and KPS score at1 month,3 months and 6 months after operation were statistically significant compared with preoperative(P<0.05).During the follow-up period,no patients developed spinal cord injury,8 patients had an improvement in spinal cord injury at 1 month postoperatively,and 12 patients had at least 1 grade improvement in the Frankle classification at 6 months postoperatively.(3)The pain,daily activity and neurological function were improved in the PVP group after surgery.The VAS score and KPS score at 1 month,3 months and 6 months after operation were statistically significant compared with preoperative(P<0.05).There was no change in Frankel grade 1 month after surgery.Six months after surgery,4 patients were aggravated by Frankle grade.(4)The pain in the conservative group was partially relieved before treatment.The VAS scores at 1 month,3 months,and 6 months after treatment were statistically significant(P<0.05).As the disease progressed,Frankle grading was increased in 2 patients 1month later.Two patients died after 6 months.Two patients underwent surgery because of unbearable painful.The Frankle grade was aggravated in 3 patients.(5)The open group and the PVP group had similar effects in relieving pain and improving mobility,and were superior to the conservative group.The VAS improvement and KPS improvement in the open group and PVP group was not statistically significant(P>0.05).The improvement of VAS and KPS in the operation group and conservative group were statistically significant(P<0.05).Conclusion: The advantage of open surgery is that the lesion can be removed as much as possible under direct vision,and the spinal cord can be directly decompressed.Patients with lesions confined to a single segment or with spinal cord compression symptoms can significantly relieve pain and preserve and improve neurological function.PVP can quickly relieve pain,and has the advantages of small trauma and good surgical tolerance.It can be used as an alternative treatment for multiple lesions or difficult to open surgery.Conservative treatment can partially relieve pain and has no significant effect on daily activity and neurological improvement. |
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