Surgery Improves Pain and Quality of Life in Multiple Myeloma Patients with Symptomatic Osteolytic Spinal Lesions
Keywords:
multiple myeloma; spinal lesions; kyphoplasty; Tumor
Abstract
Purpose: A prospective study that aims to present the functional outcome and the survival of 21 consecutive selected Multiple Myeloma (MM) patients who underwent 25 surgeries for symptomatic vertebral body osteolysis.
Methods: 25 wide spectrum surgeries including percutaneous augmentation, hybrid fixation and circumferential decompression were performed for symptomatic vertebral body osteolysis in 21 selected patients with MM. Tomita osteolysis classification, Karnofsky disability scale, ASIA neurological impairment scale and VAS pain scale were used. Survival analysis was performed.
Results: All patients were followed for a minimum of 6 months postoperatively. Karnofsky Index improved from 66%±20% preoperatively to 81.3%±15%, onemonth and 83%±10% one year postoperatively. VAS score significantly reduced in all patients from 7.08±2 preoperatively to 3.35±1.5 at the latest evaluation. One patient with ASIA grades D and 2 with ASIA grades C improved postoperatively to ASIA E. The one-year survival from index diagnosis was 85.2% (95% CI, 60.6% - 96.0%), while it dropped to 55.4% (29.4% - 75.1%) five-year postoperatively. Τhe one-year survival rate from index surgery was 65.9% (95% CI, 38.8% - 83.2%), and dropped to 33.5% (95% CI, 11.1% - 58.0%) five-years postoperatively.
Conclusions: There are several modalities of surgery for symptomatic osteolytic vertebral body lesions in MM patients. Surgery was proved a safe procedure with few complications it reduced pain and improved quality of life. Together with hematological and radiation therapy it may increase the survival of MM patients.
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References
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27. S. A. Levine, L. A. Perin, D. Hayes, and W. S. Hayes, “An evidence-based evaluation of percutaneous vertebroplasty.,” Managed care (Langhorne, Pa.), vol. 9, no. 3, pp. 56–60, 63, Mar. 2000.
28. C. Huskisson, “Measurement of pain.,” The Journal of rheumatology, vol. 9, no. 5, pp. 768–9.
29. “http://www.asia-spinalinjury.org/.” .
30. J. H. B. David A. Karnofsky, Walter H. Abelmann, Lloyd F. Craver, “The use of the nitrogen mustards in the palliative treatment of carcinoma,” Cancer, vol. 1, no. 4, pp. 634–656, 1948.
31. K. Tomita, N. Kawahara, H. Baba, H. Tsuchiya, S. Nagata, and Y. Toribatake, “Total en bloc spondylectomy for solitary spinal metastases.,” International orthopaedics, vol. 18, no. 5, pp. 291–8, Oct. 1994.
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33. N. H. von der Hoeh, S. K. Tschoeke, J. Gulow, A. Voelker, U. Siebolts, and C.-E. Heyde, “Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature.,” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Aug. 2013.
34. J.-J. Body, “Effectiveness and cost of bisphosphonate therapy in tumor bone disease.,” Cancer, vol. 97, no. 3 Suppl, pp. 859–65, Feb. 2003.
35. H. Kivioja, E. O. Karaharju, I. Elomaa, and T. O. Böhling, “Surgical treatment of myeloma of bone.,” European journal of cancer (Oxford, England : 1990), vol. 28A, no. 11, pp. 1865–9, Jan. 1992.
36. P. J. Papagelopoulos, E. C. Galanis, P. R. Greipp, and F. H. Sim, “Prosthetic hip replacement for pathologic or impending pathologic fractures in myeloma.,” Clinical orthopaedics and related research, no. 341, pp. 192–205, Aug. 1997.
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38. Julka, S. R. Tolhurst, R. C. Srinivasan, and G. P. Graziano, “Functional Outcomes and Height Restoration for Patients With Multiple Myeloma-Related Osteolytic Vertebral Compression Fractures Treated With Kyphoplasty.,” Journal of spinal disorders & techniques, Jun. 2012.
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40. J. D. Barr, M. S. Barr, T. J. Lemley, and R. M. McCann, “Percutaneous vertebroplasty for pain relief and spinal stabilization.,” Spine, vol. 25, no. 8, pp. 923–8, Apr. 2000.
41. H. Choe, E. M. Marom, K. Ahrar, M. T. Truong, and J. E. Madewell, “Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty.,” AJR. American journal of roentgenology, vol. 183, no. 4, pp. 1097–102, Oct. 2004.
42. Weill, J. Chiras, J. M. Simon, M. Rose, T. Sola-Martinez, and E. Enkaoua, “Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement.,” Radiology, vol. 199, no. 1, pp. 241–7, Apr. 1996.
43. Zeifang, A. Zahlten-Hinguranage, H. Goldschmidt, F. Cremer, L. Bernd, and D. Sabo, “Long-term survival after surgical intervention for bone disease in multiple myeloma.,” Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, vol. 16, no. 2, pp. 222–7, Feb. 2005.
44. Pascal-Moussellard, G. Broc, V. Pointillart, F. Siméon, J. M. Vital, and J. Sénégas, “Complications of vertebral metastasis surgery.,” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 7, no. 6, pp. 438–44, Jan. 1998.
45. Jónsson, L. Sjöström, H. Jónsson, and G. Karlström, “Surgery for multiple myeloma of the spine. A retrospective analysis of 12 patients.,” Acta orthopaedica Scandinavica, vol. 63, no. 2, pp. 192–4, Apr. 1992.
46. R. F. McLain and J. N. Weinstein, “Solitary plasmacytomas of the spine: a review of 84 cases.,” Journal of spinal disorders, vol. 2, no. 2, pp. 69–74, Jun. 1989.
47. Olerud and B. Jonsson, “Surgical palliation of symptomatic spinal metastases.,” Acta orthopaedica Scandinavica, vol. 67, no. 5, pp. 513–22, Oct. 1996.
2. F. Mont’Alverne, J.-N. Vallée, R. Guillevin, E. Cormier, B. Jean, M. Rose, J. G. Caldas, and J. Chiras, “Percutaneous vertebroplasty for multiple myeloma of the cervical spine.,” Neuroradiology, vol. 51, no. 4, pp. 237–42, Apr. 2009.
3. D. L. Longo, “Treatment of advanced Hodgkin lymphoma: the more things change, the more they stay the same.,” Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol. 31, no. 6, pp. 660–2, Feb. 2013.
4. Harrison’s Principles of Internal Medicine, 18th Editi. Mc Graw Hill Medical, p. 938.
5. R. E. Coleman, “Clinical features of metastatic bone disease and risk of skeletal morbidity.,” Clinical cancer research : an official journal of the American Association for Cancer Research, vol. 12, no. 20 Pt 2, p. 6243s–6249s, Oct. 2006.
6. B. Cortet, A. Cotten, N. Boutry, F. Dewatre, R. M. Flipo, B. Duquesnoy, P. Chastanet, and B. Delcambre, “Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma.,” Revue du rhumatisme (English ed.), vol. 64, no. 3, pp. 177–83, Mar. 1997.
7. G. R. Mundy, “Myeloma bone disease.,” European journal of cancer (Oxford, England : 1990), vol. 34, no. 2, pp. 246–51, Feb. 1998.
8. J. N. Weinstein and R. F. McLain, “Primary tumors of the spine.,” Spine, vol. 12, no. 9, pp. 843–51, Nov. 1987.
9. E. M. Ocio, M.-V. Mateos, P. Maiso, A. Pandiella, and J. F. San-Miguel, “New drugs in multiple myeloma: mechanisms of action and phase I/II clinical findings.,” The lancet oncology, vol. 9, no. 12, pp. 1157–65, Dec. 2008.
10. Palumbo and S. V. Rajkumar, “Treatment of newly diagnosed myeloma.,” Leukemia, vol. 23, no. 3, pp. 449–56, Mar. 2009.
11. W. I. Bensinger, “Role of autologous and allogeneic stem cell transplantation in myeloma.,” Leukemia, vol. 23, no. 3, pp. 442–8, Mar. 2009.
12. F. C. Tamburrelli, L. Proietti, L. Scaramuzzo, V. De Stefano, and C. A. Logroscino, “Bisphosphonate therapy in multiple myeloma in preventing vertebral collapses: preliminary report.,” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 21 Suppl 1, pp. S141–5, May 2012.
13. Barlogie, J. Shaughnessy, G. Tricot, J. Jacobson, M. Zangari, E. Anaissie, R. Walker, and J. Crowley, “Treatment of multiple myeloma.,” Blood, vol. 103, no. 1, pp. 20–32, Jan. 2004.
14. H. S. Yeh and J. R. Berenson, “Treatment for myeloma bone disease.,” Clinical cancer research : an official journal of the American Association for Cancer Research, vol. 12, no. 20 Pt 2, p. 6279s–6284s, Oct. 2006.
15. S. Dudeney, I. H. Lieberman, M.-K. Reinhardt, and M. Hussein, “Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma.,” Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol. 20, no. 9, pp. 2382–7, May 2002.
16. R. Fourney, D. F. Schomer, R. Nader, J. Chlan-Fourney, D. Suki, K. Ahrar, L. D. Rhines, and Z. L. Gokaslan, “Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients.,” Journal of neurosurgery, vol. 98, no. 1 Suppl, pp. 21–30, Jan. 2003.
17. G. Hadjipavlou, M. N. Tzermiadianos, P. G. Katonis, and M. Szpalski, “Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours.,” The Journal of bone and joint surgery. British volume, vol. 87, no. 12, pp. 1595–604, Dec. 2005.
18. P. Korovessis, T. Repantis, L. E. Miller, and J. E. Block, “Initial clinical experience with a novel vertebral augmentation system for treatment of symptomatic vertebral compression fractures: a case series of 26 consecutive patients.,” BMC musculoskeletal disorders, vol. 12, p. 206, Jan. 2011.
19. M. J. McGirt, S. L. Parker, J.-P. Wolinsky, T. F. Witham, A. Bydon, and Z. L. Gokaslan, “Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature.,” The spine journal : official journal of the North American Spine Society, vol. 9, no. 6, pp. 501–8, Jun. 2009.
20. J. Chiras, C. Depriester, A. Weill, M. T. Sola-Martinez, and H. Deramond, “[Percutaneous vertebral surgery. Technics and indications].,” Journal of neuroradiology. Journal de neuroradiologie, vol. 24, no. 1, pp. 45–59, Jun. 1997.
21. L. Hrabálek, J. Bacovský, V. Scudla, T. Wanek, and O. Kalita, “[Multiple spinal myeloma and its surgical management].,” Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti, vol. 90, no. 5, pp. 270–6, May 2011.
22. G. A. La Maida, L. S. Giarratana, A. Acerbi, V. Ferrari, G. V. Mineo, and B. Misaggi, “Cement leakage: safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions.,” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 21 Suppl 1, pp. S61–8, May 2012.
23. P. C. Gerszten and E. A. Monaco, “Complete percutaneous treatment of vertebral body tumors causing spinal canal compromise using a transpedicular cavitation, cement augmentation, and radiosurgical technique.,” Neurosurgical focus, vol. 27, no. 6, p. E9, Dec. 2009.
24. P. C. Gerszten and W. C. Welch, “Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures. Technical note.,” Journal of neurosurgery. Spine, vol. 6, no. 1, pp. 92–5, Jan. 2007.
25. R. J. Halpin, B. R. Bendok, and J. C. Liu, “Minimally invasive treatments for spinal metastases: vertebroplasty, kyphoplasty, and radiofrequency ablation.,” The journal of supportive oncology, vol. 2, no. 4, pp. 339–51; discussion 352–5.
26. G. A. La Maida, L. S. Giarratana, A. Acerbi, V. Ferrari, G. V. Mineo, and B. Misaggi, “Cement leakage: safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions.,” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 21 Suppl 1, pp. S61–8, May 2012.
27. S. A. Levine, L. A. Perin, D. Hayes, and W. S. Hayes, “An evidence-based evaluation of percutaneous vertebroplasty.,” Managed care (Langhorne, Pa.), vol. 9, no. 3, pp. 56–60, 63, Mar. 2000.
28. C. Huskisson, “Measurement of pain.,” The Journal of rheumatology, vol. 9, no. 5, pp. 768–9.
29. “http://www.asia-spinalinjury.org/.” .
30. J. H. B. David A. Karnofsky, Walter H. Abelmann, Lloyd F. Craver, “The use of the nitrogen mustards in the palliative treatment of carcinoma,” Cancer, vol. 1, no. 4, pp. 634–656, 1948.
31. K. Tomita, N. Kawahara, H. Baba, H. Tsuchiya, S. Nagata, and Y. Toribatake, “Total en bloc spondylectomy for solitary spinal metastases.,” International orthopaedics, vol. 18, no. 5, pp. 291–8, Oct. 1994.
32. M. P. Kaplan E.L, “Nonparametric Estimation from Incomplete Observations,” Journal of the American Statistical Association, vol. 53, no. 282, pp. 457–481, 1958.
33. N. H. von der Hoeh, S. K. Tschoeke, J. Gulow, A. Voelker, U. Siebolts, and C.-E. Heyde, “Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature.,” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Aug. 2013.
34. J.-J. Body, “Effectiveness and cost of bisphosphonate therapy in tumor bone disease.,” Cancer, vol. 97, no. 3 Suppl, pp. 859–65, Feb. 2003.
35. H. Kivioja, E. O. Karaharju, I. Elomaa, and T. O. Böhling, “Surgical treatment of myeloma of bone.,” European journal of cancer (Oxford, England : 1990), vol. 28A, no. 11, pp. 1865–9, Jan. 1992.
36. P. J. Papagelopoulos, E. C. Galanis, P. R. Greipp, and F. H. Sim, “Prosthetic hip replacement for pathologic or impending pathologic fractures in myeloma.,” Clinical orthopaedics and related research, no. 341, pp. 192–205, Aug. 1997.
37. H. R. Dürr, B. Wegener, A. Krödel, P. E. Müller, V. Jansson, and H. J. Refior, “Multiple myeloma: surgery of the spine: retrospective analysis of 27 patients.,” Spine, vol. 27, no. 3, pp. 320–4; discussion 325–6, Feb. 2002.
38. Julka, S. R. Tolhurst, R. C. Srinivasan, and G. P. Graziano, “Functional Outcomes and Height Restoration for Patients With Multiple Myeloma-Related Osteolytic Vertebral Compression Fractures Treated With Kyphoplasty.,” Journal of spinal disorders & techniques, Jun. 2012.
39. W. Burton, L. D. Rhines, and E. Mendel, “Vertebroplasty and kyphoplasty: a comprehensive review.,” Neurosurgical focus, vol. 18, no. 3, p. e1, Mar. 2005.
40. J. D. Barr, M. S. Barr, T. J. Lemley, and R. M. McCann, “Percutaneous vertebroplasty for pain relief and spinal stabilization.,” Spine, vol. 25, no. 8, pp. 923–8, Apr. 2000.
41. H. Choe, E. M. Marom, K. Ahrar, M. T. Truong, and J. E. Madewell, “Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty.,” AJR. American journal of roentgenology, vol. 183, no. 4, pp. 1097–102, Oct. 2004.
42. Weill, J. Chiras, J. M. Simon, M. Rose, T. Sola-Martinez, and E. Enkaoua, “Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement.,” Radiology, vol. 199, no. 1, pp. 241–7, Apr. 1996.
43. Zeifang, A. Zahlten-Hinguranage, H. Goldschmidt, F. Cremer, L. Bernd, and D. Sabo, “Long-term survival after surgical intervention for bone disease in multiple myeloma.,” Annals of oncology : official journal of the European Society for Medical Oncology / ESMO, vol. 16, no. 2, pp. 222–7, Feb. 2005.
44. Pascal-Moussellard, G. Broc, V. Pointillart, F. Siméon, J. M. Vital, and J. Sénégas, “Complications of vertebral metastasis surgery.,” European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 7, no. 6, pp. 438–44, Jan. 1998.
45. Jónsson, L. Sjöström, H. Jónsson, and G. Karlström, “Surgery for multiple myeloma of the spine. A retrospective analysis of 12 patients.,” Acta orthopaedica Scandinavica, vol. 63, no. 2, pp. 192–4, Apr. 1992.
46. R. F. McLain and J. N. Weinstein, “Solitary plasmacytomas of the spine: a review of 84 cases.,” Journal of spinal disorders, vol. 2, no. 2, pp. 69–74, Jun. 1989.
47. Olerud and B. Jonsson, “Surgical palliation of symptomatic spinal metastases.,” Acta orthopaedica Scandinavica, vol. 67, no. 5, pp. 513–22, Oct. 1996.
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