[Surgical treatment of myeloma localized in the spine]

Myeloma represents as much as 40 per cent of malignant primary spine tumors. The aim of this study was to discuss the indications for surgical treatment of spinal myeloma.

18 patients presenting spinal localization of myeloma were operated on. There were 10 males and 8 females. Mean age was 59.9 (41-86). Pain was present in all patients. Seven patients presented neurologic signs: Frankel B: 1 case, Frankel C: 3 cases, Frankel D: 3 cases. Surgical treatment included anterior approach in 6 cases, posterior approach in 5 cases and combined approach in 7 cases. Postoperative medical treatment (chemotherapy, radiotherapy, immunotherapy) was performed in all cases.

Diagnosis was made after surgery in 10 patients on histological findings. There were 13 myelomas and 5 plasmacytomas. Decrease of pain was observed in all cases at first postoperative month; 9 patients were pain free at the 6th postoperative month. Complications occurred in 4 cases: 2 local infections after radiotherapy; mobilisation 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 follow-up of 15.4 months. Preoperative Karnofsky score was 50 per cent; Karnofsky score was 77 per cent at follow-up. Neurologic deficit improved in 5 out of 7 cases.

Primary treatment of myeloma is medical associating chemotherapy, corticotherapy, radiotherapy and immunotherapy. Plasmocytoma is frequently revealed by neurologic deficit. Staging of myeloma gives the prognostic. Surgical treatment must be performed when pain is not controlled by medical treatment or when neurologic deficit is present.

Surgery allows rapid and durable functional recovery in patients with spinal myeloma; surgery should be associated to additional medical treatment, unlike spinal metastasis.