Diagnosis and treatment of spinal multiple myeloma:36 cases report

English Keywords:Multiple myeloma  Spine  Diagnosis  Treatment

English Abstract:

  【Abstract】 Objective：To investigate the diagnosis and treatment protocols for spinal multiple myeloma（MM）.Methods:We retrospectively analyzed 36 spinal MM patients.The patients′ ages ranged from 34 to 78 years （mean，55.5 years）.All of the patients had pain as a major complaint and 25 cases suffered from neurologic deficits.CT guided needle biopsy was performed in 26 patients.24 cases were myeloma and the orther two cases were lymphoma and cartilage tissue.Pathologic results were obtained by surgery in 5 cases，and the last 5 cases were diagnosed by bone marrow smear.Chemotherapy or stem cell bone marrow transplantation was the first choice.Surgical indication was that the patients had severe or rapidly progressed neurologic deficit or spinal instability.The indication for radiotherapy was the patients having refractory pain and mild or slowly progressive neurologic impairment.16 cases received chemotherapy（4 cases had additional radiotherapy，1 case had bone marrow transplantation），in these cases，9 cases having neurologic deficit and 7 cases having spinal instability（they were excluded from surgery because of severe osteoporosis or poor general condition）.Surgeries were performed in 16 cases（15 cases had chemotherapy including 3 cases having additional radiotherapy，and 1 case had bone marrow transplantation.2 cases received second surgery due to incomplete resolution of symptoms），ａｎｄ　１４ cases having neurologic deficit and １３ cases having spinal instability．2 cases refused any treatment and 2 cases were lost to follow up.Results:32 cases were followed-up and the follow-up period was 2-108 months（average 31.5 months）.20 patients were still alive at the last follow-up.And 12 cases died with an average living period of 19.4 months（2-40 months）.In chemotherapy cases，6 cases died；1 case was lost to follow up；and 9 cases were alive.In the alive cases，3 cases had neurologic deficit，and 1 case received chemotherapy but no improvement of neurologic function.But improvements were observed in 100% of the 2 cases with chemotherapy and radiotherapy.In 5 alive cases with spinal instability，4 cases received chemotherapy only，and 1 of those showed progression of compression fracture of vertebra.Symptoms were relieved in the chemotherapy with radiotherapy case without any follow-up radiology image.In an average 9.1 months period，no apparent recalcification was detected in all the 7 cases with chemotherapy alone.In surgery cases， 4 cases died；1 case was lost to follow up；and 11 cases were alive.9 of the alive cases had neurologic deficit.77.8%（7/9） got neurologic improvement.In the 11 cases with spinal instability，spinal stability was remained in all of them in an average of 45.9 months′ follow-up.In 9 one-stage-surgery cases，3 patients were through anterior approach，3 patients were posterior approach and 3 patients were combined approach.In a period of 52 months′ follow-up，there were no diferent results.Conclusions:CT guided needle biopsy is valuable tool in the diagnosis of multiple myeloma.Neurologic function can be improved by radiotherapy or surgery，but the indications should be strictly controlled.Spinal instability is the indication for surgery.