Spinal myeloma: surgical outcome and prognostic factors

English Keywords:Spine  Myeloma  Surgical treatment  Prognostic

English Abstract:

  【Abstract】 Objectives: To identify the clinical outcome and the survival prognostic factors of the patients with spinal myeloma, and to investigate the optimized surgical treatment strategy of the disease. Methods: The clinical data of the 85 patients with spinal myeloma who underwent surgeries in our center from March 2003 to March 2012 were reviewed retrospectively. 47 males and 38 females were enrolled with an average age of 64.8 years(ranged from 43 to 83 years). 18 cases had tumors located in cervical spine, 41 in thoracic spine and 26 in lumbar spine. 70 patients(82.3%) presented with local pain, 30 with radicular symptoms(35.3%), and 37 cases(43.5%) with spinal cord compression. Open surgery was performed in 75 cases, wile 10 patients received percutaneous vertebroplasty(PVP). Open surgery combined with vertebroplasty was performed in 15 cases. The postoperative pain relief, neurological function and quality of life and their influence factors via visual analogue scale(VAS), Eastern Cooperative Oncology Group(ECOG) score and Frankel classification were analyzed. The analysis of the optimization of VAS, ECOG score and Frankel classification was performed by paired t test. One-way anova was used to analyze the influence factors of total blood loss. The survival rate was analyzed by Kaplan-Meier method. The prognostic factors including age, gender, stage of disease, number of lesions, hemoglobin, Creatinine, C-reaction protein, Lactic acid dehydrogenase levels were analyzed univariately and multivariately by Cox comparative hazard model. Results: Among all 85 cases, 18 cases received cervical spine surgery, 41 cases received thoracic spine surgery and 26 received lumbosacral spine surgery. 70(82.3%) patients presented with local pain, 30 cases(35.3%) with radicular symptoms, and 37 patients(43.5%) with symptoms due to spinal cord compression. The average operation time was 258min and the average blood loss was 1928.48ml. The degree of pain, neurological function and quality of life were improved significantly(P<0.01). Preoperative chemotherapy(P<0.01) and vascular embolization(P=0.03) reduced blood loss during surgery. 2 patients had local recurrences. The overall complication rate was 10.5%(9/85). The median survival time was 39 months. The overall survival rate at 1 year, 3 years and 5 years was 93.9%, 70.6% and 50.6%, respectively. C-reaction protein(P<0.01, 95%CI 1.87-12.94) and Lactate dehydrogenase level(P<0.01, 95%CI 2.19-11.25) were the prognostic factors of postoperative survival. Conclusions: The current surgical strategy of spinal myeloma is effective to relieve symptoms. The complication rate is low. The overall survival time is long in spinal myeloma patients. C-reaction protein and Lactate dehydrogenase level are the prognostic factors of postoperative survival.