J Korean Neurosurg Soc.  2017 Sep;60(5):534-539. 10.3340/jkns.2016.1011.001.

Surgical Roles for Spinal Involvement of Hematological Malignancies

• Kim SI
• Kim YH
• Ha KY
• Lee JW
• Lee JW

• KMID: 2457960
• DOI: http://doi.org/10.3340/jkns.2016.1011.001

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.

Keyword

Hematologic neoplasms; Spine; Fractures; Bone; Spinal cord injuries

MeSH Terms

Diagnosis
Disease Progression
Epidemiology
Fractures, Spontaneous
Hematologic Neoplasms*
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid, Acute
Lymphoma
Male
Multiple Myeloma
Neurologic Manifestations
Palliative Care
Paralysis
Retrospective Studies
Spinal Cord Compression
Spinal Cord Injuries
Spine

Figure

• 

  Fig. 1 Distribution of primary hematological malignancies. Multiple myeloma is the leading cause of hematologic malignancies causing spinal problems. Chronic myeloid leukemia and acute myeloid leukemia followed sequentially. MM: multiple myeloma, CML: chronic myeloid leukemia, AML: acute myeloid leukemia, MDS: myelodysplastic syndrome, ALL: acute lymphocytic leukemia.

• 

  Fig. 2 Presenting symptoms in patients with spinal problems accompanied by hematological malignancies. Mechanical back pain related to pathological fracture was the main presenting symptom. Neurologic compromise as a presenting symptom was noted in 8% of this cohort.

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  Fig. 3 Distribution of the involved vertebrae. Thoracolumbar and lumbar were the mainly affected sites for the pathologic lesions related to hematologic malignancies.

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  Fig. 4 A representing case required reconstructive surgery. A 71-year-old woman presented neck pain with progressive myelopathic symptoms. Plain radiograph (A) and fat suppression magnetic resonance imaging (B) show pathologic fracture at C4 with epidural extension. Preoperative diagnostic work-ups including computed tomography guided biopsy revealed multiple myeloma. Decompressive and reconstructive surgery was performed (C).

Reference

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