Zehri Aqib H, Calafiore Rebecca L, Peterson Keyan A, Kittel Carol A, Osei Jed A, Wilson Jonathan L, Hsu Wesley
Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Division of Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
J Spine Surg. 2024 Sep 23;10(3):428-437. doi: 10.21037/jss-24-54. Epub 2024 Sep 12.
Management of multiple myeloma (MM) of the spine includes a multimodal approach consisting of chemotherapy, bisphosphonates, radiation, and surgical intervention. This study aims to explore the trends in surgical treatment of MM including hospital costs, odds of complications, and the impact of patient comorbidities on the risk of complications using the National Inpatient Sample (NIS) database.
The NIS was queried for patients with MM and plasmacytoma of the spine who underwent surgical intervention between 2005 and 2014. Rates of spinal decompression, spinal stabilization with or without decompression, and vertebral augmentation were analyzed. The effect of various patient characteristics on outcome was analyzed by multivariate analysis and stratified by surgical procedure.
Vertebral augmentation (9,643, 65.7%) was the most commonly performed procedure, followed by spinal stabilization with or without decompression (4,176, 28.4%) and then decompression alone (868, 5.9%). The total population-adjusted rate of surgical management for MM remained stable during the study period, while the rate of spinal stabilization increased (P<0.001) and the rate of vertebral augmentation decreased (P=0.01). Vertebral augmentation was associated with shorter inpatient hospital stay, lower total cost, and higher likelihood of discharging to home. The complication rate increased over time for vertebral augmentation procedures (P<0.001) while spinal stabilization and decompression complication rates remained stable. The complication rate for all procedures was higher in male patients (P<0.001) and increased with the number of patient comorbidities (P<0.001).
Spinal surgery seems to be increasing for the management of spinal MM in the inpatient setting, while the rate of vertebral augmentation is decreasing. Vertebroplasty and similar palliative procedures may continue to decrease as advancements in surgical technology and technique allow for safer surgical intervention. The decision to employ aggressive surgical intervention, however, must always take into account the patient's comorbidities, overall systemic disease burden, and the potential for significant enhancement in meaningful clinical outcome.
脊柱多发性骨髓瘤（MM）的治疗包括化疗、双膦酸盐、放疗和手术干预等多模式方法。本研究旨在利用国家住院样本（NIS）数据库探讨MM手术治疗的趋势，包括住院费用、并发症发生率以及患者合并症对并发症风险的影响。
查询NIS数据库中2005年至2014年间接受手术干预的脊柱MM和浆细胞瘤患者。分析脊柱减压、有无减压的脊柱稳定以及椎体强化的发生率。通过多变量分析并按手术方式分层分析各种患者特征对结果的影响。
椎体强化术（9643例，65.7%）是最常施行的手术，其次是有无减压的脊柱稳定术（4176例，28.4%），然后是单纯减压术（868例，5.9%）。在研究期间，MM手术治疗的总体人群调整率保持稳定，而脊柱稳定术的发生率增加（P<0.001），椎体强化术的发生率下降（P=0.01）。椎体强化术与住院时间缩短、总费用降低以及出院回家可能性更高相关。椎体强化术的并发症发生率随时间增加（P<0.001），而脊柱稳定术和减压术的并发症发生率保持稳定。所有手术的并发症发生率在男性患者中更高（P<0.001），并随患者合并症数量增加而升高（P<0.001）。
在住院环境中，脊柱MM的手术治疗似乎在增加，而椎体强化术的发生率在下降。随着手术技术的进步使手术干预更安全，椎体成形术及类似的姑息性手术可能会继续减少。然而，采用积极手术干预时，必须始终考虑患者的合并症、整体全身疾病负担以及有意义的临床结果显著改善的可能性。
