Milavec Helena, Ravikumar Nivetha, Syn Nicholas L, Yentia Soekojo Cinnie, Chng Wee Joo, Kumar Naresh
Department of Orthopaedic Surgery, National University Health System, Singapore.
Department of Orthopaedic Surgery and Traumatology, Spine Unit, Inselspital, Bern University Hospital, Bern, Switzerland.
Int J Spine Surg. 2020 Oct;14(5):785-794. doi: 10.14444/7112. Epub 2020 Oct 23.
Multiple myeloma (MM) is the most frequent primary malignancy of the spine. We aimed to investigate the clinical presentation, surgical indications and outcomes, complications, survival, and its influencing factors in surgically treated MM patients with symptomatic involvement of the spine (SIS).
Retrospective analysis of prospectively collected data. Out of 350 MM patients treated at our institution over a period of 12 years (2006-2018), we identified 24 patients who were surgically treated for SIS. We collected data on demographics, clinical presentation, comorbidities, surgical indications, and outcomes and investigated the factors predisposing to postoperative complications and survival.
The median follow-up duration was 85 months; median overall survival (OS) was 50 months. Clinical presentation at admission included pain (88%), sensory and/or motor deficit (67%), and bowel/bladder dysfunction (25%). Symptomatic pathological fractures were seen in 33%. Predominant surgical indications were rapid neurological deterioration with or without spinal cord compression (SCC), followed by mechanical instability. The majority of our patients benefited from surgery in terms of pain reduction in the short term as well as in the long term. There were 21% patients with surgical-related complications (<3 months). Surgical site infections occurred in 17%, without any obvious factors predisposing to infective complications. Neurological deterioration during hospital stay, especially in the presence of motor deficit and/or bowel/bladder dysfunction, significantly reduced OS.
Sudden-onset neurological deterioration was the predominant factor leading to surgery. We achieved good short- and long-term pain reduction. Surgery is a valuable option for MM patients with SIS who present with rapid neurological deterioration with or without SCC and/or mechanical instability.
多发性骨髓瘤（MM）是脊柱最常见的原发性恶性肿瘤。我们旨在研究有症状性脊柱受累（SIS）的接受手术治疗的MM患者的临床表现、手术指征及结果、并发症、生存率及其影响因素。
对前瞻性收集的数据进行回顾性分析。在我们机构12年（2006 - 2018年）期间治疗的350例MM患者中，我们确定了24例因SIS接受手术治疗的患者。我们收集了人口统计学、临床表现、合并症、手术指征及结果的数据，并研究了术后并发症和生存的 predisposing因素。
中位随访时间为85个月；中位总生存期（OS）为50个月。入院时的临床表现包括疼痛（88%）、感觉和/或运动功能障碍（67%）以及肠道/膀胱功能障碍（25%）。33%的患者出现有症状的病理性骨折。主要手术指征是伴有或不伴有脊髓压迫（SCC）的快速神经功能恶化，其次是机械性不稳定。我们的大多数患者在短期和长期疼痛减轻方面都从手术中获益。有21%的患者出现手术相关并发症（<3个月）。手术部位感染发生率为17%，没有任何明显的感染并发症 predisposing因素。住院期间神经功能恶化，尤其是存在运动功能障碍和/或肠道/膀胱功能障碍时，显著降低了OS。
突发神经功能恶化是导致手术的主要因素。我们实现了良好的短期和长期疼痛减轻。对于伴有或不伴有SCC和/或机械性不稳定且出现快速神经功能恶化的有SIS的MM患者，手术是一种有价值的选择。
