Surgical Treatment Algorithm for Multiple Myeloma and Solitary Plasmacytoma of the Spine

Authors: L. Hrabálek 1;  T. Wanek 1;  J. Minařík 2;  J. Bačovský 2;  V. Ščudla 2;  M. Vaverka 1
Authors‘ workplace: Neurochirurgická klinika LF UP a FN Olomouc 1;  III. interní klinika LF UP a FN Olomouc 2
Published in: Cesk Slov Neurol N 2015; 78/111(1): 64-71
Category: Original Paper


Multiple myeloma (MM) and solitary plasmacytoma (SP) are the most frequent primary tumors of the spine. Management of the spinal MM and SP is a complex process involving causal treatment to suppress the tumor clone, as well as supportive therapy, including surgery and radiotherapy. Surgery should be considered because of its favourable effect on disease prognosis. We proposed a surgical treatment algorithm in patients with spinal MM and SP and the aim of this article is to present prospective evaluation of this algorithm. Patients undergoing surgical treatment during the past 10 years were included in this study, with the minimum follow-up of one year. A total of 32 patients (20 males and 12 females) with the mean age of 61 years were included. Surgery of 61 vertebrae was performed. The procedures were indicated for progressing neurological deficit (Frankel score) and for axial spinal pain (VAS classification). We performed the following procedures: vertebroplasty, laminectomy, transpedicular fixation, somatectomy, and their combination, or occipito-cervical fixation. Frankel score and VAS was assessed one year after the surgery and X-ray and spinal MRI was performed every year. No local relapses of the tumor or stabilization failure were detected. The mean preoperative VAS was 6.8 and improved to 1.1 one year after the surgery. During the follow up period, we observed positive effect of surgery on pain control and on prevention or improvement of neurological dysfunction. The authors concluded that all surgical procedures, the extent of resection and timing were adequate in all subjects.

Key words:
multiple myeloma – solitary plasmacytoma –vertebroplasty – transpedicular fixation – somatectomy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


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