Objective:To evaluate the safety and efficacy of the technique of minimally invasive separation surgery with small incision and free hand screw placement in patients with spinal metastases.Methods:Retrospectively reviewed the clinical data of 49 consecutive patients from May 2019 to December 2019 who underwent minimally invasive separation surgery with small incision and free hand screw placement for metastatic spinal tumors. Among them, there were 21 males with an average age of 55.62±2.97 years (range: 26-75 years) and 28 females with an average age of 52.50±1.76 years (range: 34-72 years). For patients who have primary tumor history with multiple metastases, routine pre-operative biopsy is not required; but for patients whose primary tumor is unknown and who have no history of tumor, pre-operative biopsy diagnosis is required. Before operation, Karnofsky Performance status (KPS) scoring system was used to evaluate the general condition of patients, Spinal Instability Neoplastic Score (SINS) scoring system was used to evaluate the spine stability, epidural spinal cord compression (ESCC) grading system was performed to access the degree of spinal cord nerve compression, and Frankel grading system was used to evaluate the neurological function. For patients who meet inclusion and exclusion criteria ware performed for decompression and internal fixation by a minimally invasive separation surgery with small incision and free hand screw placement. The demographic, neurological function, complications and perioperative data were collected and analyzed, including pre-operation neurological function, operation time, intraoperative blood loss, postoperative suction drainage, drainage tube extraction time, complications rates, hospital stay, and assessment of neurological recovery at 4 weeks after surgery.Results:Preoperative coil embolization was performed in 1 patient with kidney cancer. The mean intraoperative blood loss was 748.60±79.39 ml. Comparison of intraoperative blood loss of 12 rich blood supply (liver cancer, kidney cancer, thyroid cancer) and 37 poor blood supply spine metastases (970.80 ml vs 676.50 ml) was not statistically significant ( P>0.05). The average operation time was 213.40±9.87 min. The operation involved 1 segment was performed in 41 patients (83.67%) and 8 patients had separation of 2 or more segments. The post-operative drainage before discharge was 494.02±63.30 ml. The average drainage tube retention time was 4.50±0.26 d and the average length of hospital stay was 7.35±0.38 d. The post-operative hospitalization was 5.31±0.29 d. 79.59% of patients had the neurological functions of Frankel grade C and D before surgery and 95.92% of patients exhibited stable and improved function at 4 weeks after surgery which was significantly improved comparing with that before surgery ( P<0.05). The complications occurred were dural rupture (1 case), infection (1 case) and hematoma (1 case). Comparison:The minimally invasive separation surgery with small incision and free hand screw placement could achieve less trauma, low complications rate, rapid postoperative recovery. It is also comparable to the traditional open separation surgery in terms of spinal stability and improvement of neurological functions. It is an excellent alternative for patient with spinal metastases.

ObjectiveTo understand the current status of human immunodeficiency virus （HIV）， Treponema pallidum （TP）， hepatitis C virus （HCV） and hepatitis B virus （HBV） infections among patients undergoing screening tests in a specialized cancer hospital in South China， and to analyze the completion of further testing for confirmation， so as to provide a reference for management of common infectious diseases and prevention of nosocomial infections. MethodsWe analyzed the positive rates of HIV antigen/antibody combination assay （HIV-comb）， TP antibody （anti-TP）， HCV antibody （anti-HCV） and hepatitis B surface antigen （HBsAg） among the outpatients and inpatients who underwent the screening tests in 2022. Then we examined the percentage of those patients with seropositivity for further confirmation. ResultsIn patients who underwent the screening tests， the positive rate， percentage of patients for further confirmation test and overall prevalence for HIV-comb were were 0.07%， 100% and 0.06%， respectively； for Anti-PT 1.99%， 100% and 0.51%， respectively. Positive rate of anti-HCV was 0.90% and 26.61% of patients completed further HCV RNA quantitative assay， in 26.44% of whom， HCV RNA levels were above the detection limit. Positive rate of HBsAg was 21.06% and 54.40% of patients completed further HBV DNA quantitative assay， in 51.60% of whom， HBV DNA levels were above the detection limit. As for the nucleic acid testing among the suspected hepatitis patients， we found smaller coverage in outpatients than in inpatients and larger coverage in liver cancer patients than in other patients. ConclusionsCompared with general population， patients in this specialized cancer hospital had similar infection levels of HIV and syphilis， and 100% of them completed further confirmation testing. Hepatitis C and hepatitis B infections were at a relatively high level， but which could not accurately reflect the level of virus replication due to insufficient coverage of nucleic acid testing. Specialized cancer hospitals should prompt medical staff to attach more importance to screening and further confirmation of common infectious diseases among tumor patients. While offering anti-cancer treatment， hospitals should also actively refer the confirmed cases with infectious diseases to designated or general hospitals for a better outcome and quality of medical services.