SURGICAL-TREATMENT OF SPINAL MYELOMA

Purpose of the study Myeloma represents as much as 40 per Gent of mali gnant primary spine tumors. The aim of this study was to discuss the i ndications far surgical treatment of spinal myeloma. Material and meth ods 18 patients presenting spinal localization of myeloma were operate d on. There were 10 males and 8 females. Mean age was 59,9 (41-86). Pa in was present in all patients. Seven patients presented neurologic si gns: Frankel B: 1 case, Frankel C: 3 cases, Frankel D: 3 cases. Surgic al treatment included anterior approach in 6 cases, posterior approach in 5 cases and combined approach in 7 cases. Postoperative medical tr eatment (chemotherapy, radiotherapy, immunotherapy) was performed in a ll cases. Results Diagnosis was made after surgery in 10 patients on h istological findings. There were 13 myelomas and 5 plasmocytomas. Decr ease of pain was observed in all cases at first postoperative month; 9 patients were pain free at the 6th postoperative month. Complications occured in 4 cases: 2 local infections after radiotherapy; mobilisati on of an anterior implant in one case and local recurrence in one case requiring secondary surgery. Nine patients were alive at review with a mean follow-up of 57 months. Nine patients were dead with a mean fol low-up of 15.4 months. Preoperative Karnofsky score was 50 per cent; K arnofsky score was 77 per cent at follow-up. Neurologic deficit improv ed in 5 out of 7 cases. Discussion Primary treatment of myeloma is med ical associating chemotherapy, corticotherapy, radiotherapy and immuno therapy. Plasmocytoma is frequently revealed by neurologic deficit, St aging of myeloma gives the prognostic. Surgical treatment must be perf ormed when pain is not controlled by medical treatment or when neurolo gic deficit is present. Conclusion Surgery allows rapid and durable fu nctional recovery in patients with spinal myeloma; surgery should be a ssociated to additional medical treatment, unlike spinal metastasis.