Surgical treatment of spinal litic lesions in patients affected by malignant haematologic diseases
EANS Academy. Telera S. 09/27/19; 276023; EP02090
Dr. Stefano Telera
Dr. Stefano Telera

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Background: Current treatments for malignant heaematologic diseases have significantly increased overall suvival (OS). Nevertheless, a compromise of quality of life (QoL) is often related to spinal involvement by the tumor or to damages to the vertebral column induced by prolonged chemo-and radiotherapies. The availability of new materials for complex spinal instrumentation and the combination of traditional decompressive techniques with mini-invasive approaches, as vertebro-kyphoplasty or percutaneous fixation have expanded the role of surgery. Different surgical options must be wisely tailored to the general and neurologic conditions of the patients.
Methods: The results of spinal surgery in 148 patients affected by Multiple Myeloma, Plasmocytoma and Lymphoma, between 2005 and 2018 have been analyzed. KPS, VAS and Dennis Pain Score were calculated pre- post-operatively and at the last FU.
Results: 109 kyphoplasty-vertebroplasty (23 open procedures), 19 laminectomy, 12 laminectomy and posterior stabilization, 8 somatectomy have been performed. FU was available for 131 patients (9-68 months). A significant improvement was observed in KPS, VAS and Dennis Pain Score in 90% of cases after surgery. Mean hospital stay was seven days. The effect of surgery on pain control and on prevention of neurologic dysfunction was maintaned over the FU period in 79% of patients. Four patients suffered post-operative haematomas. One peri-operative death and three cases of instrumentation failures occurred. OS was 38 months.
Conclusions: Symptomatic metastatic spine disease in haematologic tumors is a challenging pathology involving 15% of patients and requiring prompt recognition. The role of surgery is relevant to confirm diagnosis, particularly in controversial cases; as a tailored treatment with a reduced morbidity and mortality, even in patients with multiple vertebral lesions; to prevent dismal neurological consequences related to vertebral collapse and spinal cord compression; to maintain a good QoL in long survivors.
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