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多发性骨髓瘤所致脊髓病变:关于患者管理神经外科方面的系统评价和荟萃分析

Lesions of the spinal cord caused by multiple myeloma: A systematic review and meta-analysis regarding the neurosurgical aspects of patient management.

作者信息

Encarnacion Daniel, Chmutin Gennady E, Bozkurt Ismail, Wellington Jack, Geraldino Emmanuel Batista, Chaurasia Bipin

机构信息

Department of Neurosurgery of People of Friendship Hospital University, Moscow, Russia.

Department of Neurosurgery Medical Park Ankara Hospital, Ankara, Turkey.

出版信息

J Craniovertebr Junction Spine. 2023 Oct-Dec;14(4):313-318. doi: 10.4103/jcvjs.jcvjs_111_23. Epub 2023 Nov 29.

Abstract

BACKGROUND

Multiple Myeloma is a B-cell malignancy which can cause variety of lesions of the spine and spinal cord. The management of patients with spinal cord compression (SCC), and the efficacy and security of minimally invasive therapeutic approaches, are the main topics of discussion.

METHODS

To systematically review the scientific literature on neurosurgical aspects of MM spinal cord lesion management, a search was conducted among scientific papers in the databases ScienceDirect, Cochrane Library, and PubMed using keywords and Boolean operators. These comprise MM and lesions of the spine and spinal cord. Each database was searched from the earliest available article to January 2017.

RESULTS

According to the literature, low-dose radiotherapy, antimyeloma medications, and bisphosphonates comprise the mainstay management for symptomatic spinal lesions. The decision to operation is based on presence of myelopathy and degree of spinal cord compression.

CONCLUSIONS

As a result of the analysis, the following conclusions may be drawn: (1) surgery is a valuable option for MM patients with symptomatic spinal involvement who experience rapid neurological deterioration with SCC and/or mechanical instability and (2) it is important to ensure that the benefits of surgical treatment outweigh the risks, as patients with MM are susceptible to infections.

摘要

背景

多发性骨髓瘤是一种B细胞恶性肿瘤,可导致脊柱和脊髓的多种病变。脊髓压迫症(SCC)患者的管理以及微创治疗方法的疗效和安全性是主要讨论话题。

方法

为了系统回顾关于多发性骨髓瘤脊髓病变管理神经外科方面的科学文献,使用关键词和布尔运算符在ScienceDirect、Cochrane图书馆和PubMed数据库中的科学论文中进行了检索。这些关键词包括多发性骨髓瘤以及脊柱和脊髓病变。每个数据库从最早的可用文章搜索到2017年1月。

结果

根据文献,低剂量放疗、抗骨髓瘤药物和双膦酸盐是有症状脊柱病变的主要治疗方法。手术决策基于脊髓病的存在和脊髓压迫程度。

结论

分析结果可得出以下结论:(1)对于有症状脊柱受累且因SCC和/或机械不稳定而出现快速神经功能恶化的多发性骨髓瘤患者,手术是一种有价值的选择;(2)由于多发性骨髓瘤患者易感染,确保手术治疗的益处大于风险很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1cc/10805160/0d481e6213ad/JCVJS-14-313-g001.jpg

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本文引用的文献

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