Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

The Role of Surgery in the Treatment of Spinal Myeloma

  • Kwon, Austin-Hyuk (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science) ;
  • Chang, Ung-Kyu (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science) ;
  • Gwak, Ho-Shin (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science) ;
  • Youn, Sang-Min (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science) ;
  • Rhee, Chang-Hun (Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science)
  • Published : 2005.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: Spinal myeloma has been treated with radiation therapy and chemotherapy. However, the role of surgery was not fully evaluated. This study is performed to evaluate the efficacy of surgery in the treatment of spinal myeloma. Methods: 22 patients who were treated with surgery for spinal myeloma from August 1999 to April 2003 were analyzed. Radiological finding, surgical methods and result were reviewed in retrospective study. For compression fracture due to myeloma infiltration, percutaneous vertebroplasy(PVP) was done. Decompression surgery with or without fixation was performed for patients with neurologic deficit. The modalities of surgery consist of PVP (14 cases), corpectomy and fixation (7 cases), and laminectomy and epidural mass removal (3 cases). To evaluate clinical outcome, visual analogue pain score and Frankel neurological scale were used. Results: In 14 cases of PVP, total 57 vertebral segments were treated including 21 thoracic vertebral bodies and 36 lumbar vertebral bodies. Pain relief was achieved in all cases. The pain score changed from 7.7 (preoperatively) to 2.5 (postoperatively). And pain relief effect was maintained over than one year. Frankel grade improved in decompression cases. Conclusion: Surgical treatment can alleviate pain and improve neurologic deficit immediately in spinal myeloma patients.

Keywords

References

  1. Chataigner H, Onimus M, Polette A : Surgical treatment of myeloma localized in the spine. Rev Chir Orthop Reparatrice Appar Mot 84 : 311-318, 1998
  2. Cobb CA, Leavens ME, Eckles N : Indications for nonoperative treatment of spinal cord compression due to breast cancer. J Neurosurg 47 : 653-658, 1977 https://doi.org/10.3171/jns.1977.47.5.0653
  3. Cortet B, Cotton A, Boutry N, Dewatre F, Flipo RM, Duouesnoy B, et al : Percutaneuos vertebroplasty in patients with osteolytic metastases or multiple myeloma. Rev Rhum Engl Ed 64 : 177-183, 1997
  4. Cotton A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, et al : Percutaneous vertebroplasty for osteolytic metastases and myeloma : effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 200 : 525-530, 1996
  5. Dudeney S, Lieberman IH, Reinhardt MK, Hussein M : Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol 20 : 2382-2397, 2002 https://doi.org/10.1200/JCO.2002.09.097
  6. Durr HR, Wegener B, Krodel A, Muller PE, Jansson V, Refior HJ : Multiple myeloma : surgery of spine : retrospective analysis of 27 patients. Spine 27 : 320-326, 2002 https://doi.org/10.1097/00007632-200202010-00023
  7. Formica C, Gavino D, Giudive V : Tumors of the spine. Indication for surgical treatment. Chir Organi Mov 83 : 23-33, 1998
  8. Jonsson B, Sjostrom L, Jonsson H, Karlstrom G : Surgery for multiple myeloma of the spine. a retrospective analysis of 12 patients. Acta Orthop Scand 63 : 192-194, 1992 https://doi.org/10.3109/17453679209154821
  9. Kyle RA : Multiple myeloma : review of 869 cases. Mayo clin Proc 50 : 29-40, 1975
  10. Kim DY, Jung SK, Jo GT, Jung CK, Kim HJ : A survival analysis of surgically treated metastatic spine tumor. J Korean Neurosurg Soc 33 : 247-251, 2003
  11. Lecouvet F, Richard F, Vande Berg B, Malghem J, Maldague B, Jamart J, et al : Long term effects of localized spinal radiation therapy in vertebral fractures and focal lesions appearance in patients with multiple myeloma. Br J Hematol 96 : 743-745, 1977 https://doi.org/10.1046/j.1365-2141.1997.d01-2108.x
  12. Lecouvet FE, Vandeberg BC, Maldague BE, Michaux L, Malghem J : Vertebral compression fractures in multiple myeloma. part I. distribution and appearance at MR imaging. Radiology 204 : 195- 199, 1997
  13. Mclain RF, Weinstein JN : Solitary plasmacytomas of the spine : a review of 84 cases. J Spinal Disord 2 : 69-74, 1989
  14. Moulopoulos LA, Varma D, Dimopoulos MA, Leeds NE, Kim EE, Johnston DA, et al : Multiple myeloma : spinal MR imaging in patients with untreated newly diagnosed disease. Radiology 185 : 833-840, 1992
  15. Onimus M, Schraub S, Bertin D, Bosset JF, Guidet M : Surgical treatment of vertebral metastasis. Spine 11 : 883-891, 1986 https://doi.org/10.1097/00007632-198611000-00007
  16. Park WM, Jang JS, Rhee CH, Gwak HS, Lee SH : Percutaneous vertebroplasty in spinal metastasis and myeloma. J Korean Neurosurg Soc 29 : 1484-1490, 2000
  17. Shin MJ, Oh SH, Yoon DH, Chin DK, Cho YE, Kim YS : Surgical treatment of spinal plasma cell tumors. J Korean Neurosurg Soc 32 : 118-124, 2002
  18. Stallmeye MJ, Zoarski GH, Obuchowski AM : Optimizing patient selection in percutaneous vertebroplasty. J Vasc Interv Radiol 14 : 683- 696, 2003 https://doi.org/10.1097/01.RVI.0000064859.87207.FA
  19. Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E : Spinal metastases : indications for and results of percutaneous injection of acrylic surgical cement. Radiology 1996 : 241-247, 1996
  20. Yang SH, Kim TY, Kim BK, Ko YU, Gwak DS, Kim NG, et al : The statistical research of multiple myeloma in Korean. J Korean Hematol Soc 30 : 345-341, 1995