Park Hyung-Youl, Kim Young-Hoon, Ahn Joo-Hyun, Ha Kee-Yong, Kim Sang-Il, Jung Jae-Woong
Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Korean Neurosurg Soc. 2022 Mar;65(2):287-296. doi: 10.3340/jkns.2021.0199. Epub 2022 Jan 4.
Although radiotherapy (RT) is recommended for multiple myeloma (MM) involving spine, the treatment of choice between reconstructive surgery with RT and RT alone for pathologic vertebral fractures (PVFs) associated with structural instability or neurologic compromises remains controversial. The purpose of this study was to evaluate the clinical efficacies of reconstructive surgery with adjuvant RT for treatment of MM with PVFs by comparing with matched cohorts treated with RT alone.
Twenty-eight patients underwent reconstructive surgery followed by RT between 2008 and 2015 in a single institution, for management of PVFs associated with structural instability of the spine and/or neurologic compromises (group I). Twentyeight patients were treated with RT alone (group II) after propensity score matching in a 1-to-1 format based on instability of the spine, as well as age and performance. Clinical outcomes including the overall survival rates, duration of independent ambulation, neurological status, and numeric rating scale (NRS) for back pain were compared.
Clinical and radiological features before treatment were similar in both groups. The median survival period was similar between the two groups. However, the mean duration of independent ambulation was significantly longer in group I (88.8 months; 95% confidence interval [CI], 66.0-111.5) than in group II (39.4 months; 95% CI, 25.2-53.6) (log rank test; p=0.022). Deterioration of Frankel grade (21.4% vs. 60.7%, p=0.024) and NRS for back pain (2.7±2.2 vs. 5.0±2.7, p=0.000) at the last follow-up were higher in the group II. Treatment-related complications were similar in both groups.
In patients with unstable PVFs due to MM, reconstructive surgery may yield superior clinical outcomes compared with RT alone in maintaining independent ambulation and neurological status, as well as pain control despite similar median survival and complications.
尽管对于累及脊柱的多发性骨髓瘤（MM）推荐采用放射治疗（RT），但对于伴有结构不稳定或神经功能损害的病理性椎体骨折（PVF），在重建手术联合RT与单纯RT之间的治疗选择仍存在争议。本研究的目的是通过与单纯接受RT治疗的匹配队列进行比较，评估重建手术联合辅助RT治疗伴有PVF的MM的临床疗效。
2008年至2015年期间，在单一机构中，28例患者接受了重建手术，随后进行RT，以治疗与脊柱结构不稳定和/或神经功能损害相关的PVF（I组）。根据脊柱不稳定情况以及年龄和体能状态，以1:1的形式进行倾向评分匹配后，28例患者接受单纯RT治疗（II组）。比较包括总生存率、独立行走持续时间、神经状态和背痛数字评分量表（NRS）在内的临床结局。
两组治疗前的临床和放射学特征相似。两组的中位生存期相似。然而，I组的平均独立行走持续时间（88.8个月；95%置信区间[CI]，66.0 - 111.5）明显长于II组（39.4个月；95%CI，25.2 - 53.6）（对数秩检验；p = 0.022）。在最后一次随访时，II组的Frankel分级恶化率（21.4%对60.7%，p = 0.024）和背痛NRS评分（2.7±2.2对5.0±2.7，p = 0.000）更高。两组的治疗相关并发症相似。
对于因MM导致不稳定PVF的患者，与单纯RT相比，重建手术在维持独立行走和神经状态以及控制疼痛方面可能产生更好的临床结局，尽管中位生存期和并发症相似。
