MULTIPLE MYELOMA OF THE SPINE: SURVIVAL, COMPLICATIONS, AND NEUROLOGICAL STATUS AFTER SURGICAL TREATMENT

Cover Page


Cite item

Full Text

Abstract

Purpose – to evaluate the survival, neurological status, and complications after surgical management of patients with multiple myeloma of the spine. Materials and methods. A retrospective study of 44 patients with multiple myeloma of the spine operated in Vreden Institute of Traumatology and Orthopedics was held in the period between 2000 and 2015. Patients underwent decompressive surgery with additional spinal instrumentation. following parameters were evaluated: demographic data, pain intensity, neurological deficit, survival, and complications after surgery. Results. Overall results showed efficiency of surgical management of spinal instability and neurological compromise due to multiple myeloma of the spine. The mean postoperative survival time was 63 months. A significant improvement in VAS scale and neurological function was observed in the study population after surgery. Postoperative VAS was 7.1 scores compared with 3.6 scores preoperatively (p = 0.021). Twenty nine of 31 patients improved their neurological status. Poor life expectancy was associated with neurological deficit both before and after surgery (p<0.0001). There were 28 postoperative complications. Most frequent complications were deep wound infection and adjacent degenerative disease. There was no survival difference in cohorts with and without complications (p = 0.942).> <0.0001). There were 28 postoperative complications. Most frequent complications were deep wound infection and adjacent degenerative disease. There was no survival difference in cohorts with and without complications (p = 0.942). Conclusion. Decompression surgery with additional instrumentation significantly decrease pain intensity and improve neurological function in selected patients affected by spinal myeloma with spinal instability. Severe neurological deficit influence on survival both before and after surgery. Survival did not depend on complications.

About the authors

N. S. Zaborovskii

Vreden russian research Institute of Traumatology and orthopedics 8, ul. Akad. Baykova, St. Petersburg, 195427, Russia

Author for correspondence.
Email: n.zaborovskii@yandex.ru

Graduate Student

Russian Federation

D. A. Ptashnikov

Vreden russian research Institute of Traumatology and orthopedics 8, ul. Akad. Baykova, St. Petersburg, 195427, russia
Mechnikov North Western State Medical University 41, Kirochnaya ul., St. Petersburg, 191015, russia

Email: n.zaborovskii@yandex.ru

Dr. Sci. (Med) Professor Head of Spine Surgery and Oncology Department, Vreden Russian Research Institute of Traumatology and Orthopedics; Head of Traumatology and Orthopedics Department, Mechnikov North Western State Medical University

D. A. Mikhaylov

Vreden russian research Institute of Traumatology and orthopedics 8, ul. Akad. Baykova, St. Petersburg, 195427, russia

Email: n.zaborovskii@yandex.ru

Cand. Sci. (Med) Neurosurgeon at Spine Surgery and Oncology Department

O. A. Smekalenkov

Vreden russian research Institute of Traumatology and orthopedics 8, ul. Akad. Baykova, St. Petersburg, 195427, russia

Email: n.zaborovskii@yandex.ru

Cand. Sci. (Med) Neurosurgeon at Spine Surgery and Oncology Department

S. V. Masevnin

Vreden russian research Institute of Traumatology and orthopedics 8, ul. Akad. Baykova, St. Petersburg, 195427, russia

Email: n.zaborovskii@yandex.ru

Orthopedic Surgeon at Spine Surgery and Oncology Department

References

  1. Карагодин Д.Ф., Пташников Д.А., Усиков В.Д., Магомедов Ш.Ш. Остеосинтез позвоночника при патологических переломах на фоне распространенного метастатического поражения в сочетании с лучевой и химиотерапией. Травматология и ортопедия России. 2010;1(55):14-20.
  2. Пташников Д.А., Микайлов И.М., Засульский Ф.Ю. Травматолого-ортопедические аспекты в комплексной терапии больных множественной миеломой (лекция). Вестник гематологии. 2014;3(10)60-62.
  3. Aebi M. Spinal metastasis in the elderly. Eur Spine J. 2003;12(3) Suppl 2:S202-13.
  4. Amelot A, Moles A, Cristini J, Salaud C, Touzeau C, Hamel O, Bord E, Buffenoir K. Predictors of survival in patients with surgical spine multiple myeloma metastases. Surg Oncol. 2016;25(3):178-83. doi: 10.1016/j.suronc.2016.05.01
  5. Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T, Stoppa AM, Hulin C, Benboubker L, Garderet L, Decaux O, Leyvraz S, Vekemans MC, Voillat L, Michallet M, Pegourie B, Dumontet C, Roussel M, Leleu X, Mathiot C, Payen C, Avet-Loiseau H, Harousseau JL; IFM Investigators. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012;366(19):1782-91. doi: 10.1056/NEJMoa1114138.
  6. Bilsky MH, Laufer I, Burch S. Shifting paradigms in the treatment of metastatic spine disease. Spine. 2009;34(22 Suppl):S101-7. doi: 10.1097/BRS.0b013e3181bac4b2.
  7. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, Vrionis FD, Yamada Y, Gerszten PC, Kuklo TR. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine. 2010;13(3):324-8. doi: 10.3171/2010.3.SPINE09459.
  8. Clarke MJ, Vrionis FD. Spinal tumor surgery: management and the avoidance of complications. Cancer Control. 2014;21(2):124-32.
  9. Denaro V, Denaro L, Albo E, Papapietro N, Piccioli A, Di Martino A. Surgical management of spinal fractures and neurological involvement in patients with myeloma. Injury. 2016;6. doi: 10.1016/j.injury.2016.07.047
  10. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine 2010;35(22):1221–9. doi: 10.1097/BRS.0b013e3181e16ae2
  11. Fisher CG, Schouten R, Versteeg AL, Boriani S, Varga PP, Rhines LD, Kawahara N, Fourney D, Weir L, Reynolds JJ, Sahgal A, Fehlings MG, Gokaslan ZL. Reliability of the Spinal Instability Neoplastic Score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases. Radiat Oncol. 2014;9:69. doi: 10.1186/1748-717X-9-69.
  12. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia, I. Paraplegia. 1969;7(3):179-192.
  13. Fujibayashi S, Neo M, Miyaki K, Nakayama T, Nakamura T. The value of palliative surgery for metastatic spinal disease: satisfaction of patients and their families. Spine J. 2010;10(1):42-9. doi: 10.1016/j.spinee.2009.06.016.
  14. Kim HJ, Buchowski JM, Moussallem CD, Rose PS. Modern techniques in the treatment of patients with metastatic spine disease. J Bone Joint Surg Am. 2012;94(10):943-51. doi: 10.2106/JBJS.L00192.
  15. Lee BH, Park JO, Kim HS, Park YC, Lee HM, Moon SH. Perioperative complication and surgical outcome in patients with spine metastases: retrospective 200-case series in a single institute. Clin Neurol Neurosurg. 2014;122:80-6. doi: 10.1016/j.clineuro.2014.04.025.
  16. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-55. doi: 10.1097/00000421-198212000-00014.
  17. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. The Lancet. 2005;366(9486):643–648. doi: 10.1016/s0140-6736(05)669.
  18. Quinn RH, Randall RL, Benevenia J, Berven SH, Raskin KA. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners. Instr Course Lect. 2014;63:431-41.
  19. San Miguel J, Weisel K, Moreau P, Lacy M, Song K, Delforge M, Karlin L, Goldschmidt H, Banos A, Oriol A, Alegre A, Chen C, Cavo M, Garderet L, Ivanova V, Martinez-Lopez J, Belch A, Palumbo A, Schey S, Sonneveld P, Yu X, Sternas L, Jacques C, Zaki M, Dimopoulos M. Pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone alone for patients with relapsed and refractory multiple myeloma (MM-003): a randomised, open-label, phase 3 trial. Lancet Oncol. 2013;14(11):1055-66. doi: 10.1016/S1470-2045(13)70380-2.
  20. Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, Rhines LD, Gokaslan ZL. Diagnosis and management of metastatic spine disease. A review. J Neurosurg Spine. 2010;13(1):94-108. doi: 10.3171/2010.3.SPINE09202.
  21. Simmons ED, Zheng Y. Vertebral tumors: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:233-47.
  22. Stewart AK, Rajkumar SV, Dimopoulos MA, Masszi T, Špička I, Oriol A, Hájek R, Rosiñol L, Siegel DS, Mihaylov GG, Goranova-Marinova V, Rajnics P, Suvorov A, Niesvizky R, Jakubowiak AJ, San-Miguel JF, Ludwig H, Wang M, Maisnar V, Minarik J, Bensinger WI, Mateos MV, Ben-Yehuda D, Kukreti V, Zojwalla N, Tonda ME, Yang X, Xing B, Moreau P, Palumbo A; ASPIRE Investigators. Carfilzomib, lenalidomide, and dexamethasone for relapsed multiple myeloma. N Engl J Med. 2015;372(2):142-52. doi: 10.1056/NEJMoa1411321
  23. Terpos E, Morgan G, Dimopoulos MA, Drake MT, Lentzsch S, Raje N, Sezer O, García-Sanz R, Shimizu K, Turesson I, Reiman T, Jurczyszyn A, Merlini G, Spencer A, Leleu X, Cavo M, Munshi N, Rajkumar SV, Durie BG, Roodman GD. International Myeloma Working Group Recommendations for the Treatment of Multiple Myeloma-Related Bone Disease. Journal of Clinical Oncology. 2013;31(18):2347–2357. doi: 10.1200/jco.2012.47.7901.
  24. Terpos E, Berenson J, Raje N, Roodman GD. Management of bone disease in multiple myeloma. Expert Rev Hematol. 2014;7(1):113-25. doi: 10.1586/17474086.2013.874943.
  25. Vallabhapurapu SD, Noothi SK, Pullum DA, Lawrie CH, Pallapati R, Potluri V, Kuntzen C, Khan S, Plas DR, Orlowski RZ, Chesi M, Kuehl WM, Bergsagel PL, Karin M, Vallabhapurapu S. Transcriptional repression by the HDAC4-RelB-p52 complex regulates multiple myeloma survival and growth. Nat Commun. 2015;6:8428. doi: 10.1038/ncomms9428.
  26. Vanek P, Bradac O, Trebicky F, Saur K, de Lacy P, Benes V. Influence of the Preoperative Neurological Status on Survival After the Surgical Treatment of Symptomatic Spinal Metastases With Spinal Cord Compression. Spine. 2015;40(23):1824-30. doi: 10.1097/BRS.0000000000001141.
  27. Zadnik PL, Goodwin CR, Karami KJ, Mehta AI, Amin AG, Groves ML, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM. Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column. J Neurosurg Spine. 2015;22(3):301-9. doi: 10.3171/2014.9.SPINE14554.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies