转移性脊柱肿瘤的手术并发症和预防策略

doi:10.3877/cma.j.issn.2096-0263.2021.01.010

随着肿瘤综合治疗水平的提高，癌症患者的平均预期寿命得到延长，转移性脊柱肿瘤的发病率也越来越高。转移性脊柱肿瘤作为一种全身性疾病，需要多学科的治疗方法。其中，手术治疗是重要组成部分，可以显著缓解疼痛，恢复脊柱稳定性，降低脊髓压迫的可能性，显著改善患者的生活质量。然而，由于这些患者的健康状况较差，手术治疗会增加围手术期并发症的风险。充分认识和了解可能发生的并发症原因和预防策略有助于降低不必要并发症的发生。本文重点综述转移性脊柱肿瘤手术相关的并发症、潜在的危险因素及预防策略，为脊柱转移瘤患者的治疗提供一定的参考价值。

关键词: 脊柱肿瘤, 转移性肿瘤, 外科治疗, 并发症, 危险因素

With the improvement of comprehensive treatment for cancer, the average length of life expectancy is increased, and the incidence of metastatic spinal tumors is increasing. As a systemic disease, metastatic spinal tumor requires multidisciplinary treatment. Among which, surgical treatment is an important part, which can significantly relieve pain, restore spinal stability, reduce the possibility of spinal cord compression, and significantly improve the quality of life of patients. However, surgery increases the risk of perioperative complications due to the poor health of these patients. Fully understanding the causes of the possible complications and prevention strategies might help reduce the incidence of unnecessary complications. This review article focuses on the complications, potential risk factors and prevention strategies related to the surgery of metastatic spinal tumor, providing a certain reference value for the treatment of patients with spinal metastatic tumor.

Key words: Spinal tumor, Metastatic tumor, Surgical treatment, Complication, Risk factor, Prevention strategy

图1 纳入文献流程图

表1 转移性脊柱肿瘤的常见手术并发症和预防策略

手术并发症类型		预防策略
术中并发症
	脊髓和神经根损伤	术前：高剂量类固醇；术中：神经电生理监测；
	脊髓和神经根损伤	术后：维持脊髓灌注、类固醇激素；
	大量出血	术前：纠正凝血功能障碍、血管栓塞术、抗纤溶药物、低体温预防；术中：供瘤血管结扎、双极电凝止血、止血药品；
	大量出血	术后：密切监测血压和引流量的变化；
	硬脊膜损伤和脑脊液漏	术中：仔细分离肿瘤与硬膜的粘连、避免使用尖锐的器械、分离前彻底止血、直视下谨慎操作等；
术后并发症
	手术部位感染	术前：戒烟、纠正营养不良、控制血糖、预防使用抗生素；术中：遵守严格无菌操作原则、控制手术时间和术中出血量、严密缝合不留死腔；
	手术部位感染		术后：术后行放疗的间隔时间至少一周；
	静脉血栓栓塞	术后：抬高双侧下肢、物理预防（足底静脉泵、间歇充气加压装置、弹力袜等）、鼓励患者主动在床上做足踝部和关节的主动屈伸运动，争取早日下床活动、早期预防性应用抗凝剂；
	内固定失败	术中：合理设计和选择内固定装置和固定方式；术后：早期下床活动，密切随访；
	肿瘤复发	术后：对于富血供的原发肿瘤患者术后应密切随访。

表1 转移性脊柱肿瘤的常见手术并发症和预防策略

手术并发症类型		预防策略
术中并发症
	脊髓和神经根损伤	术前：高剂量类固醇；术中：神经电生理监测；
	脊髓和神经根损伤	术后：维持脊髓灌注、类固醇激素；
	大量出血	术前：纠正凝血功能障碍、血管栓塞术、抗纤溶药物、低体温预防；术中：供瘤血管结扎、双极电凝止血、止血药品；
	大量出血	术后：密切监测血压和引流量的变化；
	硬脊膜损伤和脑脊液漏	术中：仔细分离肿瘤与硬膜的粘连、避免使用尖锐的器械、分离前彻底止血、直视下谨慎操作等；
术后并发症
	手术部位感染	术前：戒烟、纠正营养不良、控制血糖、预防使用抗生素；术中：遵守严格无菌操作原则、控制手术时间和术中出血量、严密缝合不留死腔；
	手术部位感染		术后：术后行放疗的间隔时间至少一周；
	静脉血栓栓塞	术后：抬高双侧下肢、物理预防（足底静脉泵、间歇充气加压装置、弹力袜等）、鼓励患者主动在床上做足踝部和关节的主动屈伸运动，争取早日下床活动、早期预防性应用抗凝剂；
	内固定失败	术中：合理设计和选择内固定装置和固定方式；术后：早期下床活动，密切随访；
	肿瘤复发	术后：对于富血供的原发肿瘤患者术后应密切随访。

113	Van Der Sande JJ, Boogerd W, Kröger R, et al. Recurrent spinal epidural metastases: a prospective study with a complete follow up [J]. J Neurol Neurosurg Psychiatry, 1999, 66(5): 623-627.
114	Aizenberg MR, Fox BD, Suki D, et al. Surgical management of unknown primary tumors metastatic to the spine [J]. J Neurosurg Spine, 2012, 16(1): 86-92.
115	Chataigner H, Onimus M. Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence [J]. Eur Spine J, 2000, 9(6): 523-527.
116	Lassau N, Lamuraglia M, Koscielny S, et al. Prognostic value of angiogenesis evaluated with high-frequency and colour Doppler sonography for preoperative assessment of primary cutaneous melanomas: correlation with recurrence after a 5 year follow-up period [J]. Cancer Imaging, 2006, 6(1): 24-29.
117	Inoue K, Slaton JW, Karashima T, et al. The prognostic value of angiogenesis factor expression for predicting recurrence and metastasis of bladder cancer after neoadjuvant chemotherapy and radical cystectomy [J]. Clin Cancer Res, 2000, 6(12): 4866-4873.
118	Lau D, Leach MR, La Marca F, et al. Independent predictors of survival and the impact of repeat surgery in patients undergoing surgical treatment of spinal metastasis [J]. J Neurosurg Spine, 2012, 17(6): 565-576.
119	Zanirato A, Damilano M, Formica M, et al. Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences [J]. Eur Spine J, 2018, 27(9): 2272-2284.
120	Rades D, Huttenlocher S, Evers JN, et al. Do elderly patients benefit from surgery in addition to radiotherapy for treatment of metastatic spinal cord compression? [J]. Strahlenther Onkol, 2012, 188(5): 424-430.
121	Smetana GW. Preoperative pulmonary evaluation: identifying and reducing risks for pulmonary complications [J]. Cleve Clin J Med, 2006, 73 Suppl 1: S36-S41.
122	Luksanapruksa P, Buchowski JM, Tongsai S, et al. Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease [J]. J Neurointerv Surg, 2018, 10(6): 596-601.
123	Chung KC, Lin CH, Tsai CL, et al. Tracheomalacia as complication of stenting for esophageal injury after transsternal approach to high thoracic vertebral metastasis [J]. World Neurosurg, 2019, 125: 67-71.
124	Chaichana KL, Woodworth GF, Sciubba DM, et al. Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression [J]. Neurosurgery, 2008, 62(3): 683-692; discussion 683-92.
125	Szczerba P. Complications after Surgical Treatment of Spinal Metastases [J]. Ortop Traumatol Rehabil, 2019, 21(1): 23-31.
126	Lau D, Chan AK, Theologis AA, et al. Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients [J]. J Neurosurg Spine, 2016, 25(3): 366-378.
1	Atkinson RA, Jones A, Ousey K, et al. Management and cost of surgical site infection in patients undergoing surgery for spinal metastasis [J]. J Hosp Infect, 2017, 95(2): 148-153.
2	Quraishi NA, Rajabian A, Spencer A, et al. Reoperation rates in the surgical treatment of spinal metastases [J]. Spine J, 2015, 15: S37-43.
3	Yahanda AT, Buchowski JM, Wegner AM. Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS [J]. Ann Transl Med, 2019, 7(10): 216.
4	Yao A, Sarkiss CA, Ladner TR, et al. Contemporary spinal oncology treatment paradigms and outcomes for metastatic tumors to the spine: A systematic review of breast, prostate, renal, and lung metastases [J]. J Clin Neurosci, 2017, 41: 11-23.
5	Zhang HR, Xu MY, Yang XG, et al. Percutaneous vertebral augmentation procedures in the management of spinal metastases [J]. Cancer Lett, 2020, 475: 136-142.
6	Luksanapruksa P, Buchowski JM, Zebala LP, et al. Perioperative complications of spinal metastases surgery [J]. Clin Spine Surg, 2017, 30(1): 4-13.
7	Laufer I, Sciubba DM, Madera M, et al. Surgical management of metastatic spinal tumors [J]. Cancer Control, 2012, 19: 122-128
8	Fourney DR, Frangou EM, Ryken TC, et al. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group [J]. J Clin Oncol, 2011, 29(22): 3072-3077.
9	Schairer WW, Carrer A, Sing DC, et al. Hospital readmission rates after surgical treatment of primary and metastatic tumors of the spine [J]. Spine (Phila Pa 1976), 2014, 39: 1801-1808.
10	Patil CG, Lad SP, Santarelli J, et al. National inpatient complications and outcomes after surgery for spinal metastasis from 1993-2002 [J]. Cancer, 2007, 110(3): 625-630.
11	Quraishi N, 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.
12	Lee BH, Park JO, Kim HS, et al. Perioperative complication and surgical outcome in patients with spine metastases: retrospective 200-case series in a single institute [J]. Clin Neurol Neurosurg, 2014, 122: 80-86.
13	Chong S, Shin SH, Yoo H, et al. Single-stage posterior decompression and stabilization for metastasis of the thoracic spine: prognostic factors for functional outcome and patients' survival [J]. Spine J, 2012, 12(12): 1083-1092.
14	Ohashi M, Hirano T, Watanabe K, et al. En bloc spondylectomy for spinal metastases: detailed oncological outcomes at a minimum of 2 years after surgery [J]. Asian Spine J, 2019, 13(2): 296-304.
15	Park JH, Jeon SR. Pre- and postoperative lower extremity motor power and ambulatory status of patients with spinal cord compression due to a metastatic spinal tumor [J]. Spine (Phila Pa 1976), 2013, 38(13): E798-E802.
16	Park JH, Rhim SC, Jeon SR. Efficacy of decompression and fixation for metastatic spinal cord compression: analysis of factors prognostic for survival and postoperative ambulation [J]. J Korean Neurosurg Soc, 2011, 50(5): 434-440.
17	Park SJ, Lee CS, Chung SS. Surgical results of metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC): analysis of functional outcome, survival time, and complication [J]. Spine J, 2016, 16(3): 322-328.
18	Quraishi N, Manoharan SR, Arealis G, et al. Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC) [J]. Eur Spine J, 2013, 22 Suppl 1(Suppl 1): S21-S26.
19	Quraishi N, Arealis G, Salem KM, et al. The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale [J]. Spine J, 2015, 15(8): 1738-1743.
20	Quraishi N, Rajagopal TS, Manoharan SR, et al. Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression [J]. Eur Spine J, 2013, 22(6): 1383-1388.
21	Vanek P, Bradac O, Trebicky F, et al. Influence of the preoperative neurological status on survival after the surgical treatment of symptomatic spinal metastases with spinal cord compression [J]. Spine (Phila Pa 1976), 2015, 40(23): 1824-1830.
22	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: 287-298
23	Glicksman RM, Tjong MC, Neves-Junior WFP, et al. stereotactic ablative radiotherapy for the management of spinal metastases: a review [J]. JAMA Oncol, 2019: 5351.
24	Nater A, Sahgal A, Fehlings M. Management - spinal metastases [J]. Handb Clin Neurol, 2018, 149: 239-255.
25	Finkelstein JA, Zaveri G, Wai E, et al. A population-based study of surgery for spinal metastases. Survival rates and complications [J]. J Bone Joint Surg Br, 2003, 85(7): 1045-1050.
26	Onimus M, Papin P, Gangloff S. Results of surgical treatment of spinal thoracic and lumbar metastases [J]. Eur Spine J, 1996, 5(6): 407-411.
27	Wibmer C, Leithner A, Hofmann G, et al. Survival analysis of 254 patients after manifestation of spinal metastases: evaluation of seven preoperative scoring systems [J]. Spine (Phila Pa 1976), 2011, 36(23): 1977-1986.
28	肖建如. 脊柱转移瘤的外科治疗进展[J]. 中国癌症杂志，2012，09(003): 652-657.
29	Igoumenou VG, Mavrogenis AF, Angelini A, et al. Complications of spine surgery for metastasis [J]. Eur J Orthop Surg Traumatol, 2020, 30: 37-56.
30	Bilsky MH, Boland P, Lis E, et al. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases [J]. Spine (Phila Pa 1976), 2000, 25(17): 2240-2249, discussion 250.
31	Sakaura H, Hosono N, Mukai Y, et al. Outcome of total en bloc spondylectomy for solitary metastasis of the thoracolumbar spine [J]. J Spinal Disord Tech, 2004, 17(4): 297-300.
32	韩秀鑫，王国文，张超，等. 121例脊柱转移瘤手术治疗的疗效分析[J]. 中华骨科杂志，2014，34: 1127-1133.
33	Lau D, Leach MR, Than KD, et al. Independent predictors of complication following surgery for spinal metastasis [J]. Eur Spine J, 2013, 22(6): 1402-1407.
34	Yang W, Jiang L, Liu X, et al. Surgical complications of extraspinal tumors in the cervical spine: a report of 110 cases and literature review [J]. Eur Spine J, 2018, 27(4): 882-890.
35	Liang T, Wan Y, Zou X, et al. Is surgery for spine metastasis reasonable in patients older than 60 years? [J]. Clin Orthop Relat Res, 2013, 471(2): 628-639.
36	Ju DG, Zadnik PL, Groves ML, et al. Factors associated with improved outcomes following decompressive surgery for prostate cancer metastatic to the spine [J]. Neurosurgery, 2013, 73(4): 657-666; discussion 666.
37	Galgano M, Fridley J, Oyelese A, et al. Surgical management of spinal metastases [J]. Expert Rev Anticancer Ther, 2018, 18: 463-472.
38	Loblaw DA, Mitera G, Ford M, et al. A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression [J]. Int J Radiat Oncol Biol Phys, 2012, 84(2): 312-317.
39	Scibilia A, Raffa G, Rizzo V, et al. Intraoperative neurophysiological monitoring in spine surgery: a significant Tool for neuronal protection and functional restoration [J]. Acta Neurochir Suppl, 2017, 124: 263-270.
40	Clarke MJ, Vrionis FD. Spinal tumor surgery: management and the avoidance of complications [J]. Cancer Control, 2014, 21(2): 124-132.
41	Qiao Z, Jia N, He Q. Does preoperative transarterial embolization decrease blood loss during spine tumor surgery? [J]. Interv Neuroradiol, 2015, 21(1): 129-135.
42	Gao X, Fan T, He S, et al. A Useful Model for Predicting Intraoperative Blood Loss in Metastatic Spine Tumor Surgery [J]. Clinical spine surgery, 2020, 33: 256-262
43	Abe E, Kobayashi T, Murai H, et al. Total spondylectomy for primary malignant, aggressive benign, and solitary metastatic bone tumors of the thoracolumbar spine [J]. J Spinal Disord, 2001, 14(3): 237-246.
44	Chen YJ, Chang GC, Chen HT, et al. Surgical results of metastatic spinal cord compression secondary to non-small cell lung cancer [J]. Spine (Phila Pa 1976), 2007, 32(15): E413-E418.
45	Cho DC, Sung JK. Palliative surgery for metastatic thoracic and lumbar tumors using posterolateral transpedicular approach with posterior instrumentation [J]. Surg Neurol, 2009, 71(4): 424-433.
46	Street J, Fisher C, Sparkes J, et al. Single-stage posterolateral vertebrectomy for the management of metastatic disease of the thoracic and lumbar spine: a prospective study of an evolving surgical technique [J]. J Spinal Disord Tech, 2007, 20(7): 509-520.
47	Tanaka M, Nakahara S, Ito Y, et al. Surgical treatment of metastatic vertebral tumors [J]. Acta Med Okayama, 2009, 63: 145-150.
48	C Olerud, H Jonsson, AM Lofberg, et al. Embolization of spinal metastases reduces peroperative blood loss. 21 patients operated on for renal cell carcinoma [J]. Acta Orthop Scand, 1993, 64(1): 9-12.
49	Schmidt R, Rupp-Heim G, Dammann F, et al. Surgical therapy of vertebral metastases. Are there predictive parameters for intraoperative excessive blood loss despite preoperative embolization? [J]. Tumori, 2011, 97(1): 66-73.
50	Molina CA, Gokaslan ZL, Sciubba DM. Diagnosis and management of metastatic cervical spine tumors [J]. Orthop Clin North Am, 2012, 43(1): 75-87, viii-ix.
51	Bilsky MH, Fraser JF. Complication avoidance in vertebral column spine tumors [J]. Neurosurg Clin N Am, 2006, 17(3): 317-329, vii.
52	Ghobrial GM, Theofanis T, Darden BV, et al. Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature [J]. Neurosurg Focus, 2015, 39(4): E8.
53	Mayfield FH, Kurokawa K. Watertight closure of spinal dura mater. Technical note [J]. J Neurosurg, 1975, 43(5): 639-640.
54	Rodriguez-Olaverri JC, Zimick NC. Merola A, et al. Comparing the clinical and radiological outcomes of pedicular transvertebral screw fixation of the lumbosacral spine in spondylolisthesis versus unilateral transforaminal lumbar interbody fusion (TLIF) with posterior fixation using anterior cages [J]. Spine (Phila Pa 1976), 2008, 33(18): 1977-1981.
55	Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients [J]. J Bone Joint Surg Am, 1998, 80(12): 1728-1732.
56	Fehlings MG, David KS, Vialle L, et al. Decision making in the surgical treatment of cervical spine metastases [J]. Spine (Phila Pa 1976), 2009, 34(22 Suppl): S108-S117.
57	Tosun B, Ilbay K, Kim MS, et al. Management of persistent cerebrospinal fluid leakage following thoraco-lumbar surgery [J]. Asian Spine J, 2012, 6(3): 157-162.
58	Jenkinson MD, Simpson C, Nicholas RS, et al. Outcome predictors and complications in the management of intradural spinal tumours [J]. Eur Spine J, 2006, 15(2): 203-210.
59	Ropper AE, Huang KT, Ho AL, et al. Intraoperative cerebrospinal fluid leak in extradural spinal tumor surgery [J]. Neurospine, 2018, 15(4): 338-347.
60	Chan SM, Chodakiewitz YG, Maya MM, et al. Intracranial hypotension and cerebrospinal fluid leak [J]. Neuroimaging Clin N Am, 2019, 29(2): 213-226.
61	Kaloostian PE, Kim JE, Bydon A, et al. Intracranial hemorrhage after spine surgery [J]. J Neurosurg Spine, 2013, 19: 370-380
62	Yoo JC, Choi JJ, Lee DW, et al. Remote cerebellar hemorrhage after intradural disc surgery [J]. J Korean Neurosurg Soc, 2013, 53(2): 118-120.
63	Fernandez-Jara J, Jorge-Blanco A, Carro-Martinez A, et al. Remote cerebellar hemorrhage after lumbar spinal surgery [J]. Emerg Radiol, 2011, 18(2): 177-180.
64	Clarke MJ, Krauss WE. Cerebrospinal fluid happens [J]. World Neurosurg, 2015, 83(3): 308-310.
65	Hawk MW, Kim KD. Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas [J]. Neurosurg Focus, 2000, 9(1): e5.
66	O'connor D, Maskery N, Griffiths WE. Pseudomeningocele nerve root entrapment after lumbar discectomy [J]. Spine (Phila Pa 1976), 1998, 23(13): 1501-1502.
67	Oterdoom DL, Groen RJ, Coppes MH. Cauda equina entrapment in a pseudomeningocele after lumbar schwannoma extirpation [J]. Eur Spine J, 2010, 19 Suppl 2(Suppl 2): S158-S161.
68	Lin TY, Chen WJ, Hsieh MK, et al. Postoperative meningitis after spinal surgery: a review of 21 cases from 20,178 patients [J]. BMC Infect Dis, 2014, 14: 220.
69	Barber SM, Fridley JS, Konakondla S, et al. Cerebrospinal fluid leaks after spine tumor resection: avoidance, recognition and management [J]. Ann Transl Med, 2019, 7(10): 217.
70	Bydon M, Macki M, Xu R, et al. Spinal decompression in achondroplastic patients using high-speed drill versus ultrasonic bone curette: technical note and outcomes in 30 cases [J]. J Pediatr Orthop, 2014, 34(8): 780-786.
71	Bydon M, Xu RS, Papademetriou K, et al. Safety of spinal decompression using an ultrasonic bone curette compared with a high-speed drill: outcomes in 337 patients [J]. J Neurosurg Spine, 2013, 18(6): 627-633.
72	Weber C, Piek J, Gunawan D. Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery [J]. Eur Spine J, 2015, 24(9): 2065-2068.
73	Demura S, Kawahara N, Murakami H, et al. Surgical site infection in spinal metastasis: risk factors and countermeasures [J]. Spine (Phila Pa 1976), 2009, 34(6): 635-639.
74	Sebaaly A, El RR, Yaacoub JJ, et al. Management of spinal infections in children with cerebral palsy [J]. Orthop Traumatol Surg Res, 2016, 102(6): 801-805.
75	Sebaaly A, Shedid D, Boubez G, et al. Surgical site infection in spinal metastasis: incidence and risk factors [J]. Spine J, 2018, 18(8): 1382-1387.
76	Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections [J]. Surg Infect (Larchmt), 2012, 13(4): 234-237.
77	Kumar S, van Popta D, Rodrigues-Pinto R, et al. Risk factors for wound infection in surgery for spinal metastasis [J]. Eur Spine J, 2015, 24: 528-532
78	Mcphee IB, Williams RP, Swanson CE. Factors influencing wound healing after surgery for metastatic disease of the spine [J]. Spine (Phila Pa 1976), 1998, 23(6): 726-732; discussion 732-3.
79	Swann MC, Hoes KS, Aoun SG, et al. Postoperative complications of spine surgery [J]. Best Pract Res Clin Anaesthesiol, 2016, 30(1): 103-120.
80	Itshayek E, Yamada J, Bilsky M, et al. Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review [J]. Int J Oncol, 2010, 36(3): 533-544.
81	De La Garza RR, Longo M, Gelfand Y, et al. Timing of prophylactic anticoagulation and its effect on thromboembolic events after surgery for metastatic tumors of the spine [J]. Spine (Phila Pa 1976), 2019, 44(11): E650-E655.
82	Caine GJ, Stonelake PS, Lip GY, et al. The hypercoagulable state of malignancy: pathogenesis and current debate [J]. Neoplasia, 2002, 4(6): 465-473.
83	Rickles FR, Levine MN. Epidemiology of thrombosis in cancer [J]. Acta Haematol, 2001, 106(1/2): 6-12.
84	Groot OQ, Ogink PT, Paulino PN, et al. High risk of symptomatic venous thromboembolism after surgery for spine metastatic bone lesions: a retrospective study [J]. Clin Orthop Relat Res, 2019, 477(7): 1674-1686.
85	Blom JW, Doggen CJ, Osanto S, et al. Malignancies, prothrombotic mutations, and the risk of venous thrombosis [J]. JAMA, 2005, 293(6): 715-722.
86	Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study [J]. Arch Intern Med, 2000, 160(6): 809-815.
87	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) [J]. Chest, 2008, 133(6 Suppl): 381S-453S.
88	Clagett GP, Anderson FA, Geerts W, et al. Prevention of venous thromboembolism [J]. Chest, 1998, 114: 531S-560S.
89	Yoshioka K, Murakami H, Demura S, et al. Comparative study of the prevalence of venous thromboembolism after elective spinal surgery [J]. Orthopedics, 2013, 36(2): e223-e228.
90	Paulino PN, Ogink PT, Groot OQ, et al. Complications and reoperations after surgery for 647 patients with spine metastatic disease [J]. Spine J, 2019, 19(1): 144-156.
91	Al-Dujaili TM, Majer CN, Madhoun TE, et al. Deep venous thrombosis in spine surgery patients: incidence and hematoma formation [J]. Int Surg, 2012, 97(2): 150-154.
92	Glotzbecker MP, Bono CM, Wood KB, et al. Thromboembolic disease in spinal surgery: a systematic review [J]. Spine (Phila Pa 1976), 2009, 34(3): 291-303.
93	Kim JY, Khavanin N, Rambachan A, et al. Surgical duration and risk of venous thromboembolism [J]. JAMA Surg, 2015, 150(2): 110-117
94	Longo M, De la Garza Ramos R, Gelfand Y, et al. Incidence and Predictors of Hardware Failure After Instrumentation for Spine Metastasis: A Single-Institutional Series [J]. World Neurosurg, 2019, 125: e1170-e1175.
95	Pedreira R, Abu-Bonsrah N, Karim Ahmed A, et al. Hardware failure in patients with metastatic cancer to the spine [J]. J Clin Neurosci, 2017, 45: 166-171.
96	Akeyson EW, Mccutcheon IE. Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis [J]. J Neurosurg, 1996, 85(2): 211-220.
97	Amankulor NM, Xu R, Iorgulescu JB, et al. The incidence and patterns of hardware failure after separation surgery in patients with spinal metastatic tumors [J]. Spine J, 2014, 14(9): 1850-1859.
98	De Ruiter GC, Lobatto DJ, Wolfs JF, et al. Reconstruction with expandable cages after single- and multilevel corpectomies for spinal metastases: a prospective case series of 60 patients [J]. Spine J, 2014, 14(9): 2085-2093.
99	Heidecke V, Rainov NG, Burkert W. Results and outcome of neurosurgical treatment for extradural metastases in the cervical spine [J]. Acta Neurochir (Wien), 2003, 145(10): 873-880; discussion 880-1.
100	Jandial R, Kelly B, Chen MY. Posterior-only approach for lumbar vertebral column resection and expandable cage Reconstruction for spinal metastases [J]. J Neurosurg Spine, 2013, 19(1): 27-33.
101	Vrionis FD, Small J. Surgical management of metastatic spinal neoplasms [J]. Neurosurg Focus, 2003, 15(5): E12.
102	Donovan DJ, Huynh TV, Purdom EB, et al. Osteoradionecrosis of the cervical spine resulting from radiotherapy for primary head and neck malignancies: operative and nonoperative management. Case report [J]. J Neurosurg Spine, 2005, 3(2): 159-164.
103	Palejwala SK, Lawson KA, Kent SL, et al. Lumbar corpectomy for correction of degenerative scoliosis from osteoradionecrosis reveals a delayed complication of lumbar myxopapillary ependymoma [J]. J Clin Neurosci, 2016, 30: 160-162.
104	Kim JB, Park SW, Lee YS, et al. The effects of spinopelvic parameters and paraspinal muscle degeneration on S1 screw loosening [J]. J Korean Neurosurg Soc, 2015, 58(4): 357-362.
105	Ibrahim A, Crockard A, Antonietti P, et al. Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007 [J]. J Neurosurg Spine, 2008, 8(3): 271-278
106	Kaloostian PE, Zadnik PL, Etame AB, et al. Surgical management of primary and metastatic spinal tumors [J]. Cancer Control, 2014, 21(2): 133-139.
107	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.
108	Epstein NE. A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures [J]. Surg Neurol Int, 2014, 5(Suppl 3): S66-S73.
109	Rajah G, Rapp A, Discolo E, et al. Surgical decompression for recurrent cord compression in cancer: a case series and review of the literature [J]. Neurol Res, 2018, 40(7): 549-554.
110	Rajah G, Rapp A, Discolo E, et al. Surgical decompression for recurrent cord compression in cancer: a case series and review of the literature[J]. Neurological research, 2018, 40: 549-554.
111	Lau D, Than KD, La Marca F, et al. Independent predictors for local recurrence following surgery for spinal metastasis [J]. Acta Neurochir (Wien), 2014, 156(2): 277-282.
112	Weigel B, Maghsudi M, Neumann C, et al. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of Life [J]. Spine (Phila Pa 1976), 1999, 24(21): 2240-2246.

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Surgical complications and prevention strategies for metastatic spinal tumors

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Surgical complications and prevention strategies for metastatic spinal tumors