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  • Title: [Applications of one-stage total spondylectomy by anterior and posterior approaches for solitary plasmacytoma of cervical spine].
    Author: Wu M, Cai L, Yan F, Xu K, Sun W, Deng Z, Xie Y.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2018 Feb 15; 32(2):195-202. PubMed ID: 29806412.
    Abstract:
    OBJECTIVE: To investigate the feasibility of one-stage total spondylectomy by anterior and posterior approaches for treating solitary plasmacytoma (SP) of cervical spine. METHODS: Between June 2000 and March 2015, the clinical data, diagnosis, and treatment of 12 patients with SP of cervical spine were retrospectively analyzed. There were 8 males and 4 females, with a mean age of 46 years (range, 28-74 years). The mean disease duration was 8.4 months (range, 3-15 months). There were 2 cases in C 2 segment, 4 cases in C 3, 2 cases in C 4, 1 recurrent case in C 5, C 6, and 3 cases in C 7. According to WBB (Weinstein-Boriani-Biagini) surgical staging system, the tumor mainly occupied the vertebral body areas and expanded outside to 4 or 9 radiating zone in 8 cases, expanded both outsides to 4 or 9 radiating zones in 4 cases; 7 cases of them affected A to D layers, other 5 cases affected B to D layers. Preoperative Frankel system showed grade B in 1 case, grade C in 6 cases, and grade D in 5 cases. One vertebra segment was involved in 11 cases, and 2 vertebra segments were involved in 1 case. The unilateral vertebral artery was involved in 4 cases and bilateral vertebral artery in 1 case. One-stage total spondylectomy by anterior and posterior approaches for SP of cervical spine was applied in all patients, which all received adjuvant radiotherapy postoperatively. The operation time, intraoperative blood loss, complications, Frankel system, and visual analogue scale (VAS) score were recorded and analyzed. RESULTS: The operation time was 6.8-9.3 hours (mean, 7.2 hours), and the intraoperative blood loss was 1 100-2 600 mL (mean, 1 600 mL). Esophageal leakage occurred in 1 patient with C 5, C 6 recurrent SP at 1 week after operation and 1 case presented with fat liquefaction of wound, who were cured by symptomatic treatment. Other patients showed no neurological deficit, major vascular injury (especially vertebral artery), phrenic nerve injury, superior laryngeal nerve injury, laryngeal nerve injury, respiratory failure, or other complications. All the 12 patients were followed up 27-98 months (mean, 58 months). The symptoms of spinal cord compression disappeared or improved after operation. At last follow-up, the nerve function was recovered to Frankel grade E in all patients; the VAS score decrease to 1.1±0.7, showing significant difference when compared with preoperative value (6.7±2.7) ( t=2.485, P=0.014). Two patients had local recurrence at 29 months and 37 months after operation respectively, which were treated with adjuvant chemotherapy. One of them finally progressed to multiple myeloma and died of multiple organ failure after 43 months, the other one survived with residual tumor. One case presented with internal fixator loosening and breaking at 4 years after operation, who was performed revision surgery. The other patients had no tumor recurrence or malignant change during the follow-up, no complication such as internal fixator loosening or breaking occurred. CONCLUSION: For patients with SP of cervical spine, surgical intervention is an acceptable treatment option. One-stage total spondylectomy by anterior and posterior approaches can decline the local recurrence and relieve the symptoms of spinal cord compression, so as to improve patients' life quality. However, patients with progression to multiple myeloma should be treated with individualized therapeutic regimen, and the prognosis may be poor. 目的: 探讨一期经前后联合入路全脊椎切除加重建术治疗颈椎孤立性浆细胞瘤（solitary plasmacytoma，SP）的可行性，以期为临床治疗颈椎 SP 提供可靠、有效的手术方式。. 方法: 回顾分析 2000 年 6 月—2015 年 3 月行一期经前后联合入路全脊椎切除的 12 例颈椎 SP 患者临床资料。其中男 8 例，女 4 例；年龄 28～74 岁，平均 46 岁。病程 3～15 个月，平均 8.4 个月。发病部位：C 2 2 例，C 3 4 例，C 4 2 例，C 5、C 6 1 例且为复发病例，C 73 例。根据 WBB（Weinstein-Boriani-Biagini）分期，累及椎体且超过一侧 4 扇区或 9 扇区 8 例，同时超过两侧 4 扇区或 9 扇区 4 例；肿瘤侵及 A～D 层 7 例，B～D 层 5 例。术前脊髓损伤按 Frankel 分级，B 级 1 例，C 级 6 例，D 级 5 例。5 例椎动脉被侵袭，其中 4 例单侧累及，1 例双侧累及；病变累及单椎节 11 例，2 个椎节骨质破坏 1 例。患者术后均接受辅助放疗。记录手术时间、术中出血量；采用 Frankel 分级评价神经功能恢复情况，疼痛视觉模拟评分（VAS）评估疼痛恢复情况。. 结果: 手术时间 6.8～9.3 h，平均 7.2 h；术中出血量 1 100～2 600 mL，平均 1 600 mL。1 例 C 5、C 6 复发 SP 患者术后 1 周出现食道瘘，1 例术后出现伤口脂肪液化，均经相应处理后治愈；其余患者均未出现脊髓神经功能损伤加重，无大血管损伤（特别是椎动脉），膈神经、喉上、喉返神经损伤，呼吸衰竭等并发症。12 例患者均获随访，随访时间 27～98 个月，平均 58 个月。末次随访时神经功能均恢复至 Frankel E 级；VAS 评分由术前（6.7±2.7）分减小至（1.1±0.7）分，差异有统计学意义（ t=2.485， P=0.014）。2 例患者分别于术后 29、37 个月复发，均行辅助化疗，其中 1 例进展为多发性骨髓瘤，术后 43 个月死于多器官功能衰竭；另 1 例患者带瘤生存。1 例术后 4 年出现内固定物松动、断裂，予以翻修。其余患者随访期间均未见肿瘤复发或恶变，无内固定物松动、断裂等并发症发生。. 结论: 手术切除是治疗颈椎 SP 的主要手段，一期经前后联合入路全脊椎切除术能明显降低颈椎 SP 复发率，并能缓解脊髓压迫症状，最大限度改善患者生存质量。进展到多发性骨髓瘤的患者应接受个体化治疗，但预后较差。.
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