Solitary plasmacytoma of cervical spine: treatment and prognosis in patients with neurological lesions and spinal instability.

STUDY DESIGN

A consecutive series of 19 cases of solitary plasmacytoma (SP) of cervical spine that underwent surgical treatment and one case that underwent pure radiotherapy were observed from 1995 to 2006.

OBJECTIVE

To discuss the clinical characteristics, therapeutic methods and factors affecting prognosis of SP in the cervical spine.

SUMMARY OF BACKGROUND DATA

SP of bone is a rare plasma cell tumor which represents the proliferation of monoclonal plasma cells without evidence of significant bone marrow plasma cell infiltration. Although radical radiotherapy is the treatment of choice for SP of the bone, recommendations for treatment methods of this disease have been solely based on limited data from retrospective studies.

METHODS

Data of 20 patients with SP of the cervical spine that were identified and treated between January 1995 and December 2006 were reviewed retrospectively. There were 13 men and 7 women ranging in age from 32 to 76 years with a mean of 56 years. Among them, 1 patient underwent radiotherapy alone, and the other 19 patients received surgery with adjuvant radiotherapy. According to the Weinstein-Boriani-Biagini staging system, the surgical procedures consisted of subtotal resection and gross-total resection. All cases were managed using an anterior approach or a combined anterior and posterior approach in 1 stage. Reconstruction of the cervical spine was achieved through an anterior cervical titanium plate and titanium mesh cage filled with autoiliac graft or bone cement, or anterior and posterior combined instrumented fusion. All surgery patients received radiotherapy as adjunctive therapy postoperatively.

RESULTS

Follow-up of the 20 patients ranged from 25 to 132 months with a mean of 61 months. Neck pains improved significantly, and motor or sensory deficits disappeared or improved in varying degrees after surgery. Neurologic function level of the patients improved by 1 to 3 grades based on the Frankel grading system 3 months after surgery. All the internal fixations fused well, stability of the cervical vertebrae was secure, and no spinal instability was observed in our series. The bone graft fusion rate reached 100%. During the follow-up period, 4 surgery cases progressed to multiple myeloma (MM), in which 2 elderly patients died of respiratory and circulatory failure at 90 and 43 months, respectively. The other 15 patients achieved disease-free survival after surgery with adjunctive radiotherapy. No significant abnormality was detected on M protein, bone marrow aspiration, and emission computed tomography or positron emission tomography/computed tomography examinations.

CONCLUSION

SP of the cervical spine is relatively rare, and no typical early symptoms are present. Gross total tumor resection or total spondylectomy by piecemeal manner with adjuvant radiotherapy can markedly reduce local recurrences and lower the possibility of progressing to MM. Patients with progression to MM should be treated with individualized chemotherapy, but the prognosis may be poor.