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

Overview

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.


Sources

1. Hrabálek L, Bačovský J, Ščudla V, Wanek T, Kalita O. Mnohočetný myelom páteře a jeho chirurgická léčba. Rozhl Chir 2011; 90(5): 270– 276.

2. Minařík J, Ščudla V. Mnohočetný myelom. In: Faber E (ed). Základy hematologické dia­gnostiky. Olomouc: Univerzita Palackého v Olomouci 2012.

3. Ščudla V, Adam Z. Současné možnosti dia­gnostiky a léčby myelomové kostní nemoci v klinické praxi. Vnitř Lék 2012; 58(7,8): 164– 174.

4. Ščudla V, Heřman M, Minařík J, Pika T, Hrbek J, Bačovský J.Přínos celotělové magnetické rezonance v dia­gnostice monoklonální gamapatie nejistého významu a mnohočetného myelomu. Klin Biochem Metab 2011; 19(2): 72– 78.

5. Ščudla V, Petrová P, Lochman P, Minařík J, Pika T, Bačovský J. Úloha ukazatelů kostního metabolizmu v hodnocení myelomové kostní nemoci. Klin Biochem Metab 2013; 21(2): 71– 78.

6. Astolfi S, Scaramuzzo L, Logroscino CA. A minimally invasive surgical treatment possibility of osteolytic vertebral collapse in multiple myeloma. Eur Spine J 2009; 18 (Suppl 1): S115– S121. doi: 10.1007/ s00586‑ 009‑ 0977‑ x.

7. La Maida GA, Giarratana LS, Acerbi A, Ferrari V, Mineo GV, Misaggi B. Cement leakage: safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions. Eur Spine J 2012; 21 (Suppl 1): S61– S68. doi: 10.1007/ s00586‑ 012‑ 2221‑ 3.

8. Oakland RJ, Furtado NR, Timothy J, Hall RM. The bio­mechanics of vertebroplasty in multiple myeloma and metastatic bladder cancer: a preliminary cadaveric investigation. J Neurosurg Spine 2008; 9(5): 493– 501. doi: 10.3171/ SPI.2008.9.11.493.

9. Tancioni F, Lorenzetti M, Navarria P, Nozza A, Castagna L, Gaetani P et al. Vertebroplasty for pain relief and spinal stabilization in multiple myeloma. Neurol Sci 2010; 31(2): 151– 157. doi: 10.1007/ s10072‑ 009‑ 0197‑ 5.

10. Ha KY, Kim YH, Kim HW. Multiple myeloma and epidural spinal cord compression: case presentation and a spine surgeonś perspective. J Korean Neurosurg Soc 2013; 54: 151– 154. doi: 10.3340/ jkns.2013.54.2.151.

11. Flouzat‑ Lachaniette ChH, Allain J, Roudot‑ Thoraval F,Poignard A. Treatment of spinal epidural compres­sion due to hematological malignancies: a single institutionś retrospective experience. Eur Spine J 2013; 22: 548– 555.

12. Lee MJ, Dumonski M, Cahill P, Stanley T, Park D, Singh K.Percutaneous treatment of vertebral compression fractures: a meta‑analysis of complications. Spine 2009; 34(11): 1228– 1232. doi: 10.1097/ BRS.0b013e3181a3c742.

13. Hsiang J. An unconventional indication for open kyphoplasty: Spine J 2003; 3(6): 520– 523.

14. Pan J, Quian ZL, Sun ZY, Yang HL. Open kyphoplasty in the treatment of a painful vertebral lytic lesion with spinal cord compression caused by multiple myeloma: a case report. Oncol Lett 2013; 5(5): 1621– 1624.

15. Weitao Y, Qiqing C, Songtao G, Jiaqiang W. Open vertebroplasty in the treatment of spinal metastatic dis­ease. Clin Neurol Neurosurg 2012; 114(4): 307– 312. doi: 10.1016/ j.clineuro.2011.10.032.

16. Brenner B, Carter A, Tatarsky I, Gruszkiewicz P, Peyser E. Incidence, prognostic significance and therapeutic modalities of central nervous system involvement in multiple myeloma. Acta Haematol 1982; 68(2): 77– 83.

17. Durr HR, Wegener B, Krodel A, Miller PE, Jansson V, Refior HJ. Multiple myeloma: surgery of the spine: retrospective analysis of 27 patients. Spine 2002; 27(3): 320– 324.

18. Chataigner H, Onimus M, Polette A. Surgical treatment of myeloma localized in the spine. Rev Chir Orthop Reparatrice Appar Mot 1998; 84(4): 311– 318.

19. Renier JC, Brégeon C, Boasson M, Audran M, Emile J, Guy G et al. Spinal cord compression in multiple myeloma. Study of 10 cases. Rev Rhum Mal Osteoartic 1984; 51(4): 193– 196.

20. Jin R, Rock J, Jin JY, Janakiraman N, Kim JH, Movsas Bet al. Single fraction spine radiosurgery for myeloma epidural spinal cord compression. J Ext Ther Oncol 2009; 8(1): 35– 41.

21. Okacha N, Chrif E, Brahim E, Ali A, Abderrahman E, Gazzaz M et al. Extraosseous epidural multiple myeloma presenting with thoracic spine compression. Joint Bone Spine 2008; 75(1): 70– 72.

22. Huang W, Cao D, Ma J, Yang X, Xiao J, Zheng W et al. Solitary plasmocytoma of cervical spine. Spine 2010; 35(8): E278– E284. doi: 10.1097/ BRS.0b013e3181c9b431.

23. Ozsahin M, Tsang RW, Poortmans P, Belkacémi , Bolla M, Dincbas FO. Outcomes and patterns of failure in solitary plasmacytoma: a multicenter rare cancer network study of 258 patients. Int Radiation Oncology Biol Phys 2006; 64(1): 210– 217.

24. von der Hoech NH, Tschoeke SK, Gulow J, Voelker A, Siebolts U, Heyde CE. Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature. Eur Spine J 2014; 23: 35– 39. doi: 10.1007/ s00586‑ 013‑ 2922‑ 2.

Labels
Paediatric neurology Neurosurgery Neurology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account