Malhotra Karan, Butler Joseph S, Yu Hai Ming, Selvadurai Susanne, D'Sa Shirley, Rabin Neil, Kyriakou Charalampia, Yong Kwee, Molloy Sean
Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, People's Republic of China.
BMC Cancer. 2016 Jul 11;16:444. doi: 10.1186/s12885-016-2495-7.
Multiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures. These are painful, result in kyphosis, and impact respiratory function and quality of life. We explore the impact of time to presentation on the efficacy of spinal treatment modalities.
We retrospectively reviewed 183 patients with spinal myeloma presenting to our service over a 2 year period.
Median time from multiple myeloma diagnosis to presentation at our centre was 195 days. Eighty-four patients (45.9 %) were treated with balloon kyphoplasty and the remainder with a thoracolumbar-sacral orthosis as per our published protocol. Patients presenting earlier than 195 days from diagnosis had significant improvements in patient reported outcome measures: EuroQol 5-Dimensions (p < 0.001), Oswestry Disability Index (p < 0.001), and Visual Analogue Pain Score (p < 0.001) at follow-up, regardless of treatment. Patients presenting after 195 days, however, only experienced benefit following balloon kyphoplasty, with no significant benefit from non-operative management.
Vertebral augmentation and thoracolumbar bracing improve patient reported outcome scores in patients with spinal myeloma. However, delay in treatment negatively impacts clinical outcome, particularly if managed non-operatively. It is important to screen and treat patients with MM and back pain early to prevent deformity and improve quality of life.
多发性骨髓瘤骨溶解疾病累及脊柱会导致椎体压缩性骨折。这些骨折会引起疼痛，导致脊柱后凸，并影响呼吸功能和生活质量。我们探讨了就诊时间对脊柱治疗方式疗效的影响。
我们回顾性分析了在两年期间到我院就诊的183例脊柱骨髓瘤患者。
从多发性骨髓瘤诊断到在我院就诊的中位时间为195天。84例患者（45.9%）接受了球囊后凸成形术治疗，其余患者按照我们已发表的方案接受胸腰骶矫形器治疗。诊断后195天内就诊的患者在随访时患者报告的结局指标有显著改善：欧洲五维健康量表（p<0.001）、奥斯威斯功能障碍指数（p<0.001）和视觉模拟疼痛评分（p<0.001），无论接受何种治疗。然而，195天后就诊的患者仅在接受球囊后凸成形术后有获益，非手术治疗无显著获益。
椎体强化和胸腰骶支具可改善脊柱骨髓瘤患者报告的结局评分。然而，治疗延迟会对临床结局产生负面影响，尤其是非手术治疗时。早期筛查和治疗多发性骨髓瘤合并背痛的患者对于预防畸形和改善生活质量很重要。
