Surgical Treatment For Multiple Myeloma Of Bone

Objective To investigate the indication, object , approach, and results of thesurgical treatment of the multiple myeloma.Methods A retrospective analysis was performed in 17 patients with solitary ormultiple myeloma who underwent surgical treatment between October 1999 and October 2004. There are 10 males and 7 females with average age of 58.6 years (range 32-67 years). The surgical localizations were: vertebral column in 10 cases, humerus shaft in 1 case, proximal femur in 3 cases, femur shaft in 2 cases and pelvis in 1 case. Pain was present in all patients. Two patients had pathological bone fracture and five patients had neurological deficit. According to Frankel classification 1 case were Frankel B, 3 cases were Frankel C, and 1 case was Frankel D. Thirteen cases were diagnosed before operation, and five cases were diagnosed by pathology after operation. Seventeen patients had undergone the following surgical procedures: anterior en-bloc and partial resection, decompression and reconstruction with internal fixation were in 6 cases, laminectomy and decompression with internal fixation were in 3 cases. One patient underwent one-stage anterior-posterior en-bloc resection and decompression with internal reconstructive stabilization. Four patients underwent tumor resection and internal fixation with intra-medullary nailing or DHS. Twopatients received tumor resection and endoprothese of replacement. Just tumor resection was performed in 1 patient. Neurological impairment was evaluated according to Frankel system and quality of life was measured by the Karnofsky index. The study evaluated the complications, pain, neurological function improvement, and life quality after operation.Results The postoperative follow-up ranged lasted more than 6 months. The painwas relieved in all patients and the neurological function was improved after operation. After surgical treatment, one case was Frankel C, three cases were Frankel D, and one case was Frankel E. Life quality was also improved after surgical treatment. Comparison of their pre-surgical scores with the scores obtained 1 months and 1 year after surgery, the different between them was significant(P<0.01). During the follow-up, local recurrence was found in 2 patients, and lesion in other location was found in one patient with solitary myeloma.Conclusion Local pain was the predominant symptom in multiple myeloma,some of them suffered from pathological bone fracture and neurological deficit. Surgical treatment could effectively relive pain, stabilize and reconstruct spine, recover activity of extremity, maintain and improve neurological function, thus improve life quality of patients with multiple myeloma.