Complex Treatment of Lesions of the Spine and Spinal Cord in Multiple Myeloma: Neurosurgical Aspects

Dreval .*, Lazarev V.*, Vitrilae S.**, Gorozhanin .***, Jinjihadze R.***

* Faculty of Neurosurgery of the Russian Medical Academy of Postgraduate Education, Moscow, Russia;
** Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia;
*** Botkin Municipal Clinical Hospital, Moscow, Russia

 

The vertebral column lesion is often the first manifestation of multiple myeloma (MM). Osteolysis is a leading cause of pathologic fractures and ossalgia. Compression of the spinal cord, conditioned by a tumor or pathologic fracture, is a rather frequent phenomenon. Today surgical intervention is aimed at pain regression and improvement of neurological functions.

The research goal was to determine indications for surgical intervention and to estimate its place in the algorithm of complex treatment of cases with lesions of the spine and spinal cord, as well as to ascertain indications for percutaneous vertebroplasty (PVP).

Material and Methods. There were 44 cases (18 males and 26 females), operated for lesions of the vertebral column and spinal cord, watched in MM. As for morphologic types, there were 27 MM and 17 solitary plasmocytomas. Open interventions were performed in 37 out of 44 cases. A posterolateral approach with partial corporectomy was made in 24 patients. Posteromedian and anterior accesses were used in 11 and 2 cases respectively. Open interventions consisted in replacement of a vertebra defect with an autobone and corporodesis with an anterior or posterior allotransplant (24 cases), as well as in use of a transpedicular system (5 cases). PVP was performed in 7 patients. Complete regression of pain and neurological disorders was observed in 20 cases. Partial regression of neurological disorders was revealed in 10 patients. Neurological deficit did not differ from that, observed in a preoperative period, in 7 cases. All the patients, subjected to PVP, had practically complete regression of pain during 72 hours.

Conclusion. Neurological disturbances and impossibility of arresting pain syndrome are indications for surgery. The main purpose of PVP, performed in vertebrae lesions against a background of MM, is arrest of pain syndrome and stabilization of an injured segment.