Surgical efficacy and prognosis analysis of spinal myeloma

English Keywords:Spinal myeloma  Surgical treatment  Pain  Nerve compression  Therapeutic effect  Survival analysis  Prognosis

English Abstract:

  【Abstract】 Objectives: To assess the efficacy of surgical intervention in the management of spinal myeloma(SM) with regards to pain relief, restoration of neurological function, and enhancement of quality of life, as well as to examine the variables influencing the postoperative survival duration of patients. Methods: A retrospective analysis was conducted on the 49 patients with SM who underwent surgical treatment at the Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University and Central Hospital of Xuhui District from January 2010 to December 2022, with complete clinical and follow-up data. Among the patients, there were 28 males and 21 females, with an average age of 64.3±11.3 years, ranging from 36 to 90 years. The average operative time was 148.7±106.4mins, and the average bleeding volume was 792.1±1091.2mL. The follow-up time was 1-158 months, with an average of 52.9±37.7 months. There were 4 cases of lesions located alone in the cervical vertebrae, 20 cases in the thoracic vertebrae, 18 cases in the lumbosacral vertebrae, 4 cases in the entire spine, and 8 cases of simultaneous invasion of the thoracic and lumbar vertebrae. There were 24 cases with pain as the main complaint, 11 cases with neurological impairment, and 14 cases with concurrent symptoms. Three cases underwent anterior surgery and 46 cases underwent posterior surgery. The visual analogue scale(VAS) score, Frankel grade of spinal cord injury, and Eastern Cooperative Oncology Group(ECOG) score of patients before and after surgery were compared, and survival analysis of the patients was conducted. Results: The median VAS score and median ECOG score of the patients were 1 and 1 points respectively after surgery, which were significantly lower than before surgery(7 and 2 points respectively, both P<0.001). The median Frankel grade was E, which was significantly improved compared to preoperative D grade(P<0.001). One case of spinal implant related complications and two cases of new extraspinal lesions occurred after surgery, and no recurrence was observed during follow-up at the surgical site. 12 deaths were caused by the progression of myeloma. The 1-year, 5-year, and 10-year survival rates of the patients were 89.8%, 79.5%, and 75.5%, respectively. Univariate analysis showed that preoperative hemoglobin, blood creatinine, and postoperative comprehensive treatment were the risk factors affecting patient prognosis(P<0.1). Cox multiple regression analysis showed that postoperative comprehensive treatment can significantly improve the survival time of patients(P<0.01). Conclusions: Surgical treatment for SM can effectively alleviate spinal instability, pain and nerve compression symptoms in patients, and significantly improve their qualities of life. Postoperative comprehensive treatments such as chemotherapy, immunotherapy, or targeted therapy are independent influencing factors for improving patient survival.