Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Roles for Spinal Involvement of Hematological Malignancies

  • Kim, Sang-Il (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Young-Hoon (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ha, Kee-Yong (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jae-Won (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jin-Woo (Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2016.11.01
  • Accepted : 2017.02.13
  • Published : 2017.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Patients with hematological malignancies frequently encounter spine-related symptoms, which are caused by disease itself or process of treatment. However, there is still lack of knowledge on their epidemiology and clinical courses. The purpose of this article is to review clinical presentations and surgical results for spinal involvement of hematologic malignancies. Methods : From January 2011 to September 2014, 195 patients (98 males and 97 females) suffering from hematological malignancies combined with spinal problems were retrospectively analyzed for clinical and radiological characteristics and their clinical results. Results : The most common diagnosis of hematological malignancy was multiple myeloma (96 patients, 49.7%), followed by chronic myeloid leukemia (30, 15.2%), acute myeloid leukemia (22, 11.2%), and lymphoma (15, 7.56%). The major presenting symptoms were mechanical axial pain (132, 67.7%) resulting from pathologic fractures, and followed by radiating pain (49, 25.1%). Progressive neurologic deficits were noted in 15 patients (7.7%), which revealed as cord compression by epidural mass or compressive myelopathy combined with pathologic fractures. Reconstructive surgery for neurologic compromise was done in 16 patients. Even though surgical intervention was useful for early paralysis (Frankel grade D or E), neurologic recovery was not satisfactory for the progressed paralysis (Frankel grade A or B). Conclusion : Hematological malignancies may cause various spinal problems related to disease progression or consequences of treatments. Conservative and palliative treatments are mainstay for these lesions. However, timely surgical interventions should be considered for the cases of pathologic fractures with progressive neurologic compromise.

Keywords

References

  1. Bickels J, Dadia S, Lidar Z : Surgical management of metastatic bone disease. J Bone Joint Surg Am 91 : 1503-1516, 2009 https://doi.org/10.2106/JBJS.H.00175
  2. Blade J, Rosinol L : Complications of multiple myeloma. Hematol Oncol Clin North Am 21 : 1231-1246, xi, 2007 https://doi.org/10.1016/j.hoc.2007.08.006
  3. Cavaletti G, Jakubowiak AJ : Peripheral neuropathy during bortezomib treatment of multiple myeloma: a review of recent studies. Leuk Lymphoma 51 : 1178-1187, 2010 https://doi.org/10.3109/10428194.2010.483303
  4. Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C, et al. : Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J 19 : 215-222, 2010 https://doi.org/10.1007/s00586-009-1252-x
  5. Durr HR, Muller PE, Hiller E, Maier M, Baur A, Jansson V, et al. : Malignant lymphoma of bone. Arch Orthop Trauma Surg 122 : 10-16, 2002 https://doi.org/10.1007/s004020100316
  6. Durr HR, Wegener B, Krodel A, Muller PE, Jansson V, Refior HJ : Multiple myeloma: surgery of the spine: retrospective analysis of 27 patients. Spine (Phila Pa 1976) 27 : 320-324; discussion 325-326, 2002 https://doi.org/10.1097/00007632-200202010-00023
  7. Flouzat-Lachaniette CH, Allain J, Roudot-Thoraval F, Poignard A : Treatment of spinal epidural compression due to hematological malignancies: a single institution's retrospective experience. Eur Spine J 22 : 548-555, 2013 https://doi.org/10.1007/s00586-012-2562-y
  8. Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, et al. : Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 29 : 3072-3077, 2011 https://doi.org/10.1200/JCO.2010.34.3897
  9. Ha KY, Min CK, Seo JY, Kim YH, Ahn JH, Hyun NM, et al. : Bone cement augmentation procedures for spinal pathologic fractures by multiple myeloma. J Korean Med Sci 30 : 88-94, 2015
  10. Hage WD, Aboulafia AJ, Aboulafia DM : Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am 31 : 515-528, vii, 2000 https://doi.org/10.1016/S0030-5898(05)70171-1
  11. Hameed A, Brady JJ, Dowling P, Clynes M, O'Gorman P : Bone disease in multiple myeloma: pathophysiology and management. Cancer Growth Metastasis 7 : 33-42, 2014
  12. Kaloostian PE, Yurter A, Zadnik PL, Sciubba DM, Gokaslan ZL : Current paradigms for metastatic spinal disease: an evidence-based review. Ann Surg Oncol 21 : 248-262, 2014 https://doi.org/10.1245/s10434-013-3324-8
  13. Lal A, Tallman MS, Soble MB, Golubovich I, Peterson L : Hairy cell leukemia presenting as localized skeletal involvement. Leuk Lyhmphoma 43 : 2207-2211, 2002 https://doi.org/10.1080/1042819021000016122
  14. Muta T, Osaki K, Yamano Y : Translocation t(9;22) (p23;q11) in atypical chronic myeloid leukemia (aCML) presenting osteolytic lesions. Int J Hematol 76 : 344-348, 2002 https://doi.org/10.1007/BF02982694
  15. Niscola P, Arcuri E, Giovannini M, Scaramucci L, Romani C, Palombi F, et al. : Pain syndromes in haematological malignancies: an overview. Hematol J 5 : 293-303, 2004 https://doi.org/10.1038/sj.thj.6200530
  16. Popescu M, Popov V, Popescu G, Dobrea C, Sandu A, Grigorean VT, et al. : Spinal involvement with spinal cord compression syndrome in hematological diseases. Rom J Morphol Embryol 53 : 1069-1072, 2012
  17. Recht L, Mrugala M : Neurologic complications of hematologic neoplasms. Neurol Clin 21 : 87-105, 2003 https://doi.org/10.1016/S0733-8619(02)00030-0
  18. Rodriguez-Abreu D, Bordoni A, Zucca E : Epidemiology of hematological malignancies. Ann Oncol 18 Suppl 1 : i3-i8, 2007
  19. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T : Surgical strategy for spinal metastases. Spine (Phila Pa 1976) 26 : 298-306, 2001 https://doi.org/10.1097/00007632-200102010-00016
  20. Utzschneider S, Schmidt H, Weber P, Schmidt GP, Jansson V, Durr HR : Surgical therapy of skeletal complications in multiple myeloma. Int Orthop 35 : 1209-1213, 2011 https://doi.org/10.1007/s00264-010-1127-0
  21. Zadnik PL, Goodwin CR, Karami KJ, Mehta AI, Amin AG, Groves ML, et al. : Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column. J Neurosurg Spine 22 : 301-309, 2015 https://doi.org/10.3171/2014.9.SPINE14554

Cited by

  1. PKP/PVP combine chemotherapy in the treatment of multiple myeloma patients with vertebral pathological fractures: minimum 3-year follow-up of 108 cases vol.14, pp.None, 2017, https://doi.org/10.1186/s13018-019-1078-0
  2. Impact of local treatment on survival from hematological malignancies causing spinal cord compression vol.11, pp.None, 2017, https://doi.org/10.25259/sni_592_2020