The Explore Of The Surgical Treatment For Spinal Myeloma

Objective：Multiple myeloma was a kind of malignant tumor caused bythe abnormal proliferation of monoclonal plasma cells.Usually,the initialsymptoms were Skeletal symptoms, the spine were most frequently involved.Osteolytic destructions，pathological fractures and spinal deformity werecaused by osteolytic destructions. The patients often presented with intractablepain symptoms and nerve and spinal cord compression injury symptoms thatseriously affected the quality of life of the patients. At this time，It wasdifficult to alleviate the symptoms of patients with pure chemotherapy.Surgical operations were considered as a reasonable and effective method oftreatment for these patients.The study made a retrospective analysis of thecliniacal histories and operation results of the spinal lesions in multiplemyeloma patients,to To investigate the value of the surgical operationtreatments of the patients with multiple myeloma in the spine.Method： It made a retrospective analysis of cliniacal history andoperation results of15patients with spinal myeloma from2011January to2012September. These15patients were initially diagnosed as MyelomaAccording to the diagnostic criteria which was recommended by theInternational Myeloma Working Group (IMWG). All the patients werepathologically confirmed as myeloma after operation. There were9males and6females with the average age of61.5years(age from46to82).There were9patients with one one damaged vertebral body,5patients with two damagedvertebral bodies and1patient with three damaged vertebral bodies. A total of22vertebrae were involved..The primary affected vertebrae were：thoracicvertebra in13, lumbar vertebra in7,cervical vertebra in2. Various degrees ofspinal cord or nerve root compression symptoms were found in11patientswhich included7patients with painful radiating to shoulder, hip and limbs and2cases with paraplegia. Based on the preoperative physical condition of patients and the degree of destruction in vertebral bodies, vertebral lesionswere divided into type A and B. We chose Percutaneous kyphoplasty(PKP) totreat these patients with type A vertebrals.For these patients with type Bvertebrals,open operations （including anterior， posterior or combinedapproach operations for the excision of focus）were recommended accordingto the physical condition of patients and the destruction of vertebra. Allpatients were transferred to the Department of hematology for furtherchemotherapy. At the same time, we chose10patients without surgicaltherapy who were treating in the Department of hematology as the controlgroup. There were6males and4females with the average age of60.5yearsold.Evaluation criteria：We evaluated the pain of these patients beforesurgery,3days and2weeks after operation on the basis of Visual AnalogueScale（VAS）standard. On the basis of the Kamofsky score standard,weevaluated the quality of life of the patients before operation,1and6monthsafter operation on operation group and the quality of life of the patients beforechemotherapy and6months after chemotherapy on the control group. Thedatum were analyzed by paired T-test or two independent samples T-test usingSPSS13.0statistical software. The measurement data used mean±standarddeviation(x±s).Set α=0.05,there was statistical significance if P <0.05for thedifference.Results: In operation period all patients were safely and withoutcomplications. The mean follow-up time was11.3months when the follow-uptime was more than6months.During this time,local recurrence were found in2patients.1The pain was relieved after operation. The preoperative VAS score of thesepatients was7.90±0.61，3days after operation it reducd to2.87±0.92，2weeks after operation the score was2.80±0.92. Using paired-samples t-test，we compared the VAS score between before operation and3days afteroperation,P＜0.001, according to the alpha=0.05level, the differencebetween preoperative score and the score of3days after operation was significant. In like manner, we compared the score between before operationand2weeks after operation,P＜0.001,the difference between preoperativescore and the score of2weeks after operation was significant.2The quality of life of the patients improved after operation. The preoperativeKamofsky score of these patients was41.13±3.91，1month after operation itcame to58.30±7.51，6months after operation the score was67.00±12.20.Using paired-samples t-test，we compared the score between before operationand1month after operation， P＜0.001, according to the alpha=0.05level，the difference of Kamofsky score between them was significant. In likemanner，P＜0.001，the difference of the score between before operation and6months after operation was significant.3Compared with chemotherapy, operation could improve the quality of life ofpatients.On operation group,the preoperative Kamofsky score was41.13±3.91,6months after operation the score was67.00±12.20.On control group,thepretherapy score was43.70±3.62,6months after chemotherapy,the score was46.90±6.87. Using two-samples t-test，compared the pretherapy score on thetwo groups, t=-1.7, P＞0.05, according to the alpha=0.05level,the differenceof pretherapy Kamofsky score between the two groups was insignificant.Using the same method, compared the6months post-treatment score on thetwo groups, t=4.7, P＜0.001, according to the alpha=0.05level,the differenceof the post-treatment Kamofsky score between the two groups was significant.4Six months after operation, limb numbness and pain radiating of Patientswho had various degrees of spinal cord or nerve root compression symptomshad different degrees of ease or disappear.2cases suffering from neurologicaldeficit had Frankel scale improved.Conclusion: For the spinal myeloma patients with neurological deficit andintractable pain, surgical operation can:1relieve intractable pain in a short time;2improve the quality of life of patients;3removal of nerve and spinal cord compression directly, alleviate nerveand spinal cord compression symptoms 4stable structure reconstruction of the spine.