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Treatment of spinal epidural compression due to hematological malignancies: a single institution's retrospective
Charles-Henri Flouzat-Lachaniette1, Jérôme Allain, Françoise Roudot-Thoraval
1Hôpital Henri MONDOR, AP-HP-UPEC, Institut du Rachis, Service de Chirurgie Orthopédique et Traumatologique, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Creteil Cedex, France. charles-henri.flouzat-lachaniette@hmn.aphp.fr
Purpose:
To analyze the neurological and mechanical outcomes in 44 consecutive patients treated for a hematological malignancy with epidural localization to assess the place of surgery in the treatment of this pathology.
Methods:
Clinical records, CT and MRI scans of 44 patients with epidural localizations of multiple myeloma or lymphoma treated between 1990 and 2005 were analyzed retrospectively. Neurological status, epiduritis and osteolysis volumes, vertebral collapse, and spinal canal compromise were assessed. The neurological outcome was graded according to Frankel and the mechanical outcome was evaluated on the rate of vertebral collapse.
Results:
Surgery was performed in 11 patients (25 %) for neurological (n = 9) or mechanical (n = 2) reasons. In five cases, a concomitant biopsy was performed because the etiology of the epiduritis was unknown. Fifteen patients (34.1 %) presented with a neurological deficit secondary to an acute vertebral collapse (n = 4), an epiduritis (n = 7), or both (n = 4). Whatever the treatment (surgical or not), a complete recovery (Frankel E) occurred in 14/15 (93.3 %) after a mean delay of 12 weeks (range 2-24 weeks). During the follow-up, seven collapses occurred. We estimated that a threshold of 30 % of osteolysis was associated with a significant risk of vertebral collapse (P = 0.005).
Conclusions:
Hematological malignancies with epidural localization must be treated first medically, even in patients with neurological symptoms. Surgery should be considered only in the cases of acute vertebral collapse, medical treatment failure, or to prevent acute collapse in patients with vertebral osteolysis of more than 30 %.
