Year: 2024
Type: article
Study design: Clinical Trial
Abstract: INTRODUCTION. Autopsy data indicate that metastatic involvement of the spine occurs in over 70 % of cancer patients. Treatment for this condition is predominantly palliative. Advances in spinal oncology are presenting new surgical technologies that minimize the extent of surgical intervention while maximizing the preservation of the patient’s quality of life. One innovative approach is laser interstitial thermotherapy.AIM. To evaluate the impact of laser interstitial thermotherapy on functional activity, neurological status, and quality of life in patients with spinal tumors.MATERIALS AND METHODS. The study sample comprised 60 middle-aged patients diagnosed with spinal tumors. The cohort was divided into two groups of 30 individuals each. Patients in the experimental group underwent surgery utilizing the LAHTA-MILON semiconductor laser. The surgical procedure was conducted in two phases: Phase 1 involved transcutaneous intracapsular exposure to tumor nodes located near the paravertebral region under ultrasound guidance using a laser. Phase 2 entailed intraoperative exposure to tumor tissue located proximal to the dural sac and nerve roots. Patient conditions were evaluated prior to surgery, one day postoperatively, and before hospital discharge (days 7–10). Severity of motor deficits was quantified on a five-point scale. Assessment of sensory deficits incorporated examinations for changes in both superficial and deep sensory modalities, as well as the categorization of disturbances (segmental versus conductive). The Frankel scale facilitated the evaluation of surgical outcomes and quality of life across both groups in pre- and postoperative phases. Data analysis was performed utilizing the standard Statistica 10.0 software package.RESULTS. The findings reveal that motor deficits were observed in 55 of 60 patients (91.7 %). By the 10th postoperative day, regression of motor deficits occurred in both groups, with 16.7 % of the control group and 26.7 % of the experimental group demonstrating improvement. Additionally, the prevalence of motor deficits diminished overall. Sensory disturbances were initially identified in 58 (96.7 %) of the patients. By the 10th postoperative day, sensory deficits of varying severity persisted in 22 (73.3 %) patients in the experimental group and 23 (76.7 %) patients in the control group. A month postoperatively, regression of sensory deficits was notable: 96.7 to 46.7 % in the experimental group and 96.7 to 60 % in the control group, yielding statistically significant results. Radicular pain syndrome was initially present in 41 (68.3%) patients, encompassing 19 (63.3 %) in the control group and 21 (73.3 %) in the experimental group. By the 10th postoperative day, radicular pain syndrome regressed in 47 (78.3 %) of the total cohort, with persistence in 13 (21.7 %) patients; in the control group, pain persisted in 6 (20 %) patients, while in the experimental group, it persisted in 7 (23.3 %) patients. Notably, functional outcomes in the experimental group, utilizing laser interstitial thermotherapy, were significantly superior compared to the control group by day 10 post-surgery. Specifically, 4 (13.3 %) patients in the experimental group achieved good outcomes, 16 (53.3 %) satisfactory outcomes, and 10 (30.3 %) poor outcomes. In contrast, the control group yielded good outcomes for 2 (6.7 %) patients, satisfactory outcomes for 8 (26.7 %), and poor outcomes for 20 (66.6 %) patients. The employment of surgical lasers in lumbosacral tumor resections resulted in reduced hemorrhage, with estimated blood loss of (210.5±20.6) ml in the experimental group compared to (350.0±21.3) ml in the control group, and (498.7±75.9) ml versus (910.5±97.6) ml overall.CONCLUSION. The application of the LAHTA-MILON laser, in contrast to conventional surgical methodologies, diminishes traction and trauma to the spinal column and its nerve roots, leading to reduced severity of neurological symptoms and enhanced quality of life in the postoperative period.
Authors: S. A. Turanov, A. V. Ivanenko, A. V. Kudziev, E. V. Adieva, D. A. Sitovskaia, A. Z. Gagiev, A. S. Tsyndyaykina
Institution: Federal Almazov North-West Medical Research Centre
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4411539169