Patel Manan Sunil, Ghasem Alexander, Greif Dylan N, Huntley Samuel R, Conway Sheila A, Al Maaieh Motasem
University of Miami Miller School of Medicine, Miami, Florida.
University of Miami, Department of Orthopedic Surgery, Miami, Florida.
Int J Spine Surg. 2018 Oct 15;12(5):571-581. doi: 10.14444/5070. eCollection 2018 Oct.
Vertebral disease is a major cause of morbidity in 70% of patients diagnosed with multiple myeloma (MM). Associated osteolytic lesions and vertebral fractures are well documented in causing debilitating pain, functional restrictions, spinal deformity, and cord compression. Currently, treatment modalities for refractory MM spinal pain include systemic therapy, radiotherapy, cementoplasty (vertebroplasty/kyphoplasty), and radio frequency ablation. Our objectives were to report on the efficacy of existing treatments for MM patients with refractory spinal pain, to determine if a standardized treatment algorithm has been described, and to set the foundation upon which future prospective studies can be designed.
A systematic search of the PubMed database was performed for studies relevant to the treatment of vertebral disease in MM patients. A multitude of search terms in various combinations were used, including but not limited to: "vertebroplasty," "kyphoplasty," "radiation," "multiple myeloma," "radiotherapy," and "radiosurgery."
Our preliminary search resulted in 219 articles, which subsequently resulted in 19 papers following abstract, title, full-text, and bibliography review. These papers were then grouped by treatment modality: radiotherapy, cementoplasty, or combination therapy. Significant pain and functional score improvement across all treatment modalities was found in the majority of the literature. While complications of treatment occurred, few were noted to be clinically significant.
Treatment options-radiotherapy and/or cementoplasty-for vertebral lesions and pathologic fractures in MM patients demonstrate significant radiographic and clinical improvement. However, there is no consensus in the literature as to the optimal treatment modality as a result of a limited number of studies reporting head-to-head comparisons. One study did find significantly improved pain and functional scores with preserved vertebral height in favor of kyphoplasty over radiotherapy. When not contraindicated, we advocate for some form of cementoplasty. Further prospective studies are required before implementation of a standardized treatment protocol.
在70%被诊断为多发性骨髓瘤（MM）的患者中，脊柱疾病是发病的主要原因。相关的溶骨性病变和椎体骨折导致的疼痛使人衰弱、功能受限、脊柱畸形以及脊髓受压，这些均有充分的文献记载。目前，难治性MM脊柱疼痛的治疗方式包括全身治疗、放射治疗、骨水泥成形术（椎体成形术/后凸成形术）以及射频消融。我们的目的是报告现有治疗对难治性脊柱疼痛MM患者的疗效，确定是否已描述标准化治疗方案，并为未来前瞻性研究的设计奠定基础。
对PubMed数据库进行系统检索，以查找与MM患者脊柱疾病治疗相关的研究。使用了多种组合的大量检索词，包括但不限于：“椎体成形术”“后凸成形术”“放射”“多发性骨髓瘤”“放射治疗”和“放射外科”。
我们的初步检索得到219篇文章，经摘要、标题、全文和参考文献审查后，最终得到19篇论文。这些论文随后按治疗方式分组：放射治疗、骨水泥成形术或联合治疗。大多数文献发现所有治疗方式在疼痛和功能评分方面均有显著改善。虽然发生了治疗相关并发症，但很少有具有临床意义的情况。
MM患者椎体病变和病理性骨折的治疗选择——放射治疗和/或骨水泥成形术——显示出显著的影像学和临床改善。然而，由于报告直接比较的研究数量有限，文献中对于最佳治疗方式尚无共识。一项研究确实发现，与放射治疗相比，后凸成形术在改善疼痛和功能评分以及保持椎体高度方面具有显著优势。在无禁忌证时，我们提倡某种形式的骨水泥成形术。在实施标准化治疗方案之前，需要进一步的前瞻性研究。
5级
