転移性脊椎腫瘍に対する手術方針

Surgical Management of Metastatic Spinal Tumors

Point

・転移性脊椎腫瘍の病態診断（脊椎不安定性，脊髄圧迫，放射線感受性）に基づいて，最適な手術手技と放射線療法を選択する．

・脊椎固定術のアプローチには従来のopen法とMIS（minimally invasive surgery）法があり，適用可能であればMIS法を選択する．

・除圧術の手技は，椎弓切除，separation surgeryから椎体切除まで多岐にわたり，症例ごとの使い分けが重要である．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　Historically, metastatic spinal tumors have been treated using open spinal fixation, invasive decompressive techniques, and low-dose palliative conventional external beam radiotherapy. As patients with metastatic disease are now living longer, the need for long-term local tumor control is becoming important. Spine stereotactic body radiotherapy has emerged as a valuable alternative option to achieve long-term local tumor control by delivering high doses of radiation to tumors and sparing the spinal cord. In recent years, minimally invasive spinal fixation and less-invasive decompressive techniques, such as separation surgery, have become increasingly important in the management of metastatic spinal tumors. In this review, we discuss the indications for these therapeutic options and the variables that should be considered when managing these patients.