李娟 1 , 石銳 2 , 余萍 1
  • 1 四川省腫瘤醫(yī)院肺部腫瘤病區(qū)（成都，610041）;2 四川大學(xué)華西醫(yī)院科技發(fā)展中心;

【摘要】 轉(zhuǎn)移性硬膜外脊髓壓迫（metastatic epidural spinal cord compression，MESCC），也稱(chēng)惡性脊髓壓迫，是惡性腫瘤最嚴(yán)重的并發(fā)癥之一。臨床上主要表現(xiàn)為背痛，肌力下降，感覺(jué)改變，嚴(yán)重者會(huì)出現(xiàn)行走能力的喪失和括約肌功能障礙。新的診斷方法和治療手段的出現(xiàn)，為MESCC的治療帶來(lái)了更多的希望，也提出了更多的挑戰(zhàn)。

引用本文： 李娟,石銳,余萍. 惡性脊髓壓迫癥的治療策略. 華西醫(yī)學(xué), 2010, 25(12): 2286-2290. doi: 復(fù)制

1. 　Loblaw DA, Laperriere NJ. Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline[J]. J Clin Oncol, 1998, 16(4): 1613-1624.
2. 　Sun H, Nemecek AN. Optimal management of malignant epidural spinal cord compression[J]. Hematol Oncol Clin North Am, 2010, 24(3): 537-551.
3. 　Abrahm JL, Banffy MB, Harris MB. Spinal cord compression in patients with advanced metastatic cancer: "all I care about is walking and living my life" [J]. JAMA, 2008, 299(8): 937-946.
4. 　Loblaw DA, Laperriere NJ, Mackillop WJ. A population-based study of malignant spinal cord compression in Ontario[J]. Clin Oncol, 2003, 15(4): 211-217.
5. 　Cole JS, Patchell RA. Metastatic epidural spinal cord compression[J]. Lancet Neurol, 2008, 7(5): 459-466.
6. 　Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment[J]. Ann Neurol, 1978, 3(1): 40-51.
7. 　Loblaw DA, Perry J, Chambers A, et al. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group[J]. J Clin Oncol, 2005, 23(9): 2028-2037.
8. 　Colletti PM, Siegel HJ, Woo MY, et al. The impact on treatment planning of MRI of the spine in patients suspected of vertebral metastasis: an efficacy study[J]. Comput Med Imaging Graph, 1996, 20(3): 159-162.
9. 　Ruckdeschel JC. Early detection and treatment of spinal cord compression[J]. Oncology, 2005, 19(1): 81-86.
10. 　Gosfield E, Alavi A, Kneeland B. Comparison of radionuclide bone scans and magnetic resonance imaging in detecting spinal metastases[J]. J Nucl Med, 1993, 34(12): 2191-2198.
11. 　George R, Jeba J, Ramkumar G, et al. Interventions for the treatment of metastatic extradural spinal cord compression in adults[J]. Cochrane Database Syst Rev, 2008, 8(4): CD006716.
12. 　Sorensen S, Helweg-Larsen S, Mouridsen H, et al. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial[J]. Eur J Cancer, 1994, 30A(1): 22-27.
13. 　Vecht CJ, Haaxma-Reiche H, van Putten WL, et al. Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression[J]. Neurology, 1989, 39(9): 1255-1257.
14. 　Rades D, Fehlauer F, Schulte R, et al. Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression[J]. J Clin Oncol, 2006, 24(21): 3388-3393.
15. 　Rades D, Dunst J, Schild SE. The first score predicting overall survival in patients with metastatic spinal cord compression[J]. Cancer, 2008, 112(1): 157-161.
16. 　Sze WM, Shelley MD, Held I, et al. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy--a systematic review of randomised trials[J]. Clin Oncol, 2003, 15(6): 345-352.
17. 　Maranzano E, Bellavita R, Rossi R, et al. Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase Ⅲ, randomized, multicenter trial[J]. J Clin Oncol, 2005, 23(15): 3358-3365.
18. 　Rades D, Stalpers LJ, Veninga T, et al. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression[J]. J Clin Oncol, 2005, 23(15): 3366-3375.
19. 　Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial[J]. Int J Radiat Oncol Biol Phys, 1995, 32(4): 959-967.
20. 　Ross JR, Saunders Y, Edmonds PM, et al. Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer[J]. BMJ, 2003, 327(7413): 469.
21. 　Quraishi NA, Gokaslan ZL, Boriani S. The surgical management of metastatic epidural compression of the spinal cord[J]. J Bone Joint Surg Br, 2010, 92(8): 1054-1060.
22. 　Greenberg HS, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol[J]. Ann Neurol, 1980, 8(4): 361-366.
23. 　Findlay GF. Adverse effects of the management of malignant spinal cord compression[J]. J Neurol Neurosurg Psychiatry, 1984, 47(8): 761-768.
24. 　Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy[J]. J Neurosurg, 1980, 53(6): 741-748.
25. 　North RB, LaRocca VR, Schwartz J, et al. Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience[J]. J Neurosurg Spine, 2005, 2(5): 564-573.
26. 　Wang JC, Boland P, Mitra N, et al. Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004[J]. J Neurosurg Spine, 2004, 1(3): 287-298.
27. 　Klimo P, Jr, Thompson CJ, Kestle JR, et al. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease[J]. Neuro Oncol, 2005, 7(1): 64-76.
28. 　Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial[J]. Lancet, 2005, 366(9486): 643-648.
29. 　Alvarez L, Perez HA, Quinones D, et al. Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life[J]. Eur Spine J, 2003, 12(4): 356-360.
30. 　Georgy BA. Bone Cement Deposition Patterns with Plasma-Mediated Radio-Frequency Ablation and Cement Augmentation for Advanced Metastatic Spine Lesions[J]. AJNR Am J Neuroradiol, 2009, 30(6): 1197-1202.
31. 　Lane MD, Le HB, Lee S, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients[J]. Skeletal Radiol, 2011, 40(1): 25-32.
32. 　Schiff D, Shaw EG, Cascino TL. Outcome after spinal reirradiation for malignant epidural spinal cord compression[J]. Ann Neurol, 1995, 37(5): 583-589.
33. 　Wong CS, Van Dyk J, Milosevic M, et al. Radiation myelopathy following single courses of radiotherapy and retreatment[J]. Int J Radiat Oncol Biol Phys, 1994, 30(3): 575-581.
  1. 1. 　Loblaw DA, Laperriere NJ. Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline[J]. J Clin Oncol, 1998, 16(4): 1613-1624.
  2. 2. 　Sun H, Nemecek AN. Optimal management of malignant epidural spinal cord compression[J]. Hematol Oncol Clin North Am, 2010, 24(3): 537-551.
  3. 3. 　Abrahm JL, Banffy MB, Harris MB. Spinal cord compression in patients with advanced metastatic cancer: "all I care about is walking and living my life" [J]. JAMA, 2008, 299(8): 937-946.
  4. 4. 　Loblaw DA, Laperriere NJ, Mackillop WJ. A population-based study of malignant spinal cord compression in Ontario[J]. Clin Oncol, 2003, 15(4): 211-217.
  5. 5. 　Cole JS, Patchell RA. Metastatic epidural spinal cord compression[J]. Lancet Neurol, 2008, 7(5): 459-466.
  6. 6. 　Gilbert RW, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment[J]. Ann Neurol, 1978, 3(1): 40-51.
  7. 7. 　Loblaw DA, Perry J, Chambers A, et al. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group[J]. J Clin Oncol, 2005, 23(9): 2028-2037.
  8. 8. 　Colletti PM, Siegel HJ, Woo MY, et al. The impact on treatment planning of MRI of the spine in patients suspected of vertebral metastasis: an efficacy study[J]. Comput Med Imaging Graph, 1996, 20(3): 159-162.
  9. 9. 　Ruckdeschel JC. Early detection and treatment of spinal cord compression[J]. Oncology, 2005, 19(1): 81-86.
  10. 10. 　Gosfield E, Alavi A, Kneeland B. Comparison of radionuclide bone scans and magnetic resonance imaging in detecting spinal metastases[J]. J Nucl Med, 1993, 34(12): 2191-2198.
  11. 11. 　George R, Jeba J, Ramkumar G, et al. Interventions for the treatment of metastatic extradural spinal cord compression in adults[J]. Cochrane Database Syst Rev, 2008, 8(4): CD006716.
  12. 12. 　Sorensen S, Helweg-Larsen S, Mouridsen H, et al. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial[J]. Eur J Cancer, 1994, 30A(1): 22-27.
  13. 13. 　Vecht CJ, Haaxma-Reiche H, van Putten WL, et al. Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression[J]. Neurology, 1989, 39(9): 1255-1257.
  14. 14. 　Rades D, Fehlauer F, Schulte R, et al. Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression[J]. J Clin Oncol, 2006, 24(21): 3388-3393.
  15. 15. 　Rades D, Dunst J, Schild SE. The first score predicting overall survival in patients with metastatic spinal cord compression[J]. Cancer, 2008, 112(1): 157-161.
  16. 16. 　Sze WM, Shelley MD, Held I, et al. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy--a systematic review of randomised trials[J]. Clin Oncol, 2003, 15(6): 345-352.
  17. 17. 　Maranzano E, Bellavita R, Rossi R, et al. Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase Ⅲ, randomized, multicenter trial[J]. J Clin Oncol, 2005, 23(15): 3358-3365.
  18. 18. 　Rades D, Stalpers LJ, Veninga T, et al. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression[J]. J Clin Oncol, 2005, 23(15): 3366-3375.
  19. 19. 　Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial[J]. Int J Radiat Oncol Biol Phys, 1995, 32(4): 959-967.
  20. 20. 　Ross JR, Saunders Y, Edmonds PM, et al. Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer[J]. BMJ, 2003, 327(7413): 469.
  21. 21. 　Quraishi NA, Gokaslan ZL, Boriani S. The surgical management of metastatic epidural compression of the spinal cord[J]. J Bone Joint Surg Br, 2010, 92(8): 1054-1060.
  22. 22. 　Greenberg HS, Kim JH, Posner JB. Epidural spinal cord compression from metastatic tumor: results with a new treatment protocol[J]. Ann Neurol, 1980, 8(4): 361-366.
  23. 23. 　Findlay GF. Adverse effects of the management of malignant spinal cord compression[J]. J Neurol Neurosurg Psychiatry, 1984, 47(8): 761-768.
  24. 24. 　Young RF, Post EM, King GA. Treatment of spinal epidural metastases. Randomized prospective comparison of laminectomy and radiotherapy[J]. J Neurosurg, 1980, 53(6): 741-748.
  25. 25. 　North RB, LaRocca VR, Schwartz J, et al. Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience[J]. J Neurosurg Spine, 2005, 2(5): 564-573.
  26. 26. 　Wang JC, Boland P, Mitra N, et al. Single-stage posterolateral transpedicular approach for resection of epidural metastatic spine tumors involving the vertebral body with circumferential reconstruction: results in 140 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004[J]. J Neurosurg Spine, 2004, 1(3): 287-298.
  27. 27. 　Klimo P, Jr, Thompson CJ, Kestle JR, et al. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease[J]. Neuro Oncol, 2005, 7(1): 64-76.
  28. 28. 　Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial[J]. Lancet, 2005, 366(9486): 643-648.
  29. 29. 　Alvarez L, Perez HA, Quinones D, et al. Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life[J]. Eur Spine J, 2003, 12(4): 356-360.
  30. 30. 　Georgy BA. Bone Cement Deposition Patterns with Plasma-Mediated Radio-Frequency Ablation and Cement Augmentation for Advanced Metastatic Spine Lesions[J]. AJNR Am J Neuroradiol, 2009, 30(6): 1197-1202.
  31. 31. 　Lane MD, Le HB, Lee S, et al. Combination radiofrequency ablation and cementoplasty for palliative treatment of painful neoplastic bone metastasis: experience with 53 treated lesions in 36 patients[J]. Skeletal Radiol, 2011, 40(1): 25-32.
  32. 32. 　Schiff D, Shaw EG, Cascino TL. Outcome after spinal reirradiation for malignant epidural spinal cord compression[J]. Ann Neurol, 1995, 37(5): 583-589.
  33. 33. 　Wong CS, Van Dyk J, Milosevic M, et al. Radiation myelopathy following single courses of radiotherapy and retreatment[J]. Int J Radiat Oncol Biol Phys, 1994, 30(3): 575-581.