: 23 S00017242 1

-----------------------------------------------------------------------------1 -----------------------------------------------------------------------------3 -------------------------------------------------------------------7 -------------------------------------------------------------------------31 -------------------------------------------------------------------------32 ----------------------------------------------------------------------33 ----------------------------------------------------------------------------------37 -------------------------------------------------------------------39 ----------------------------------------------------------------------------45 ----------------------------------------------------------------------------------49 ----------------------------------------------------------------------------------57 ----------------------------------------------------------------------------57 ----------------------------------------------------------------------------------61 ----------------------------------------------------------------------------------62 ----------------------------------------------------------------------------85 ----------------------------------------------------------------------------------87 ----------------------------------------------------------------------------89 2

23 23 18 5 35 63 49.4 16 2 3 3 4 1 1 23 9 13 5 23 7 9 Frankel B C 1 Frankel D 7 7 18 16 14 CT 14 6 5 Kaneda 1 CSLP1 VentroFix3 8 5 1 3

1 3 VentroFix 1 USS 2 Luque 1 2 Luque 1 54 1 Luque 23 4 15 4 M X 13 5 >15% 1 M 18.75% 14 7 Frankel E 5 E B C 1 1 E D 7 2 D 5 E 1 CT 2 3 CT 4

Diagnosis and Surgical Treatment of Spinal Myeloma Retrospective Analysis of 23 Cases M.S. Candidate: DIAO Yinze Tutor: MA Qingjun,Prof. Institution: Dept.of Orthopaedics, Peking University Third Hospital, Beijing 100083,China Abstract Objective: To sum up the experience in diagnosis and surgical treatment of spinal myeloma. Methods: A retrospective analysis was made of the data of 23 patients with spinal myeloma, 18 males and 5 females, with the mean age of 49.4 years (range 35-63 years). A solitary lesion which localized in one spinal segment was seen in 16 cases, in two adjacent segments was seen in 2 cases, three adjacent segments in 3 cases, four adjacent segments in 1 case, and multiple lesions which were not adjoining with each other were seen in 1 case. Cervical spine was involved in 9 patients, thoracic spine in 13 patients and lumbar spine in 5 patients. Sacral lesion was not seen in this series. Spinal pain was present in all patients, 7 patients presented with 5

radicular pain and 9 with dysfunction of spinal cord ( Frankel classification B in 1 case, C in 1 case, D in 7 cases; 7 cases with dysfunction of sphincters). In addition to routine laboratory and radiologic examinations, iliac bone marrow aspiration biopsy was taken in 18 patients, serum electrophoresis was taken in 16 patients. 14 patients underwent percutaneous spinal biopsy guided by CT. Surgical procedures were performed in 14 cases. 6 patients whose lesions localized mainly in vertebral bodies were operated in anterior approach for tumor resection and stabilization. 5 out of the 8 patients whose vertebral lesions developed to posterior elements were operated in combined approach for tumor resection, and the other 3 patients were operated in posterior approach. Radiotherapy or chemotherapy or both were given to all patients. Results: 4 patients were diagnosed by pathology after operation, 15 patients by biopsy of spinal lesion before operation (1 case by open biopsy), and 4 patients by iliac aspiration biopsy, serum electrophoresis and systemic X-ray examination. 13 patients were diagnosed as multiple myeloma, but only 5 of them had a percentage of plasma cells above 15% in iliac aspiration biopsy. Large amount of M protein was found only in one case (whose percentage of plasma cells in iliac aspiration biopsy was 18.75%). Majority of patients diagnosed as multiple myeloma showed negative or low level in the two tests. In the 14 patients who underwent operations pain 6

and radicular pain were all relieved, dysfunction of sphincters of 7 cases was corrected, 5 cases of Frankel E remained that level, 2 cases respectively of Frankel B and C regained Frankel E one year after operation. 2 out of the 7 cases of Frankel D failed to follow up, the other 5 cases regained Frankel E. Conclusions: 1) Percutaneous spinal biopsy guided by CT is an important method in the diagnosis of spinal myeloma, and maybe is necessary for majority of the patients. 2) Selective surgical treatment for patients with spinal myeloma can relieve pain, improve neurological functions and elevate life quality. 3) Radiotherapy and chemotherapy are important treatments to consolidate the effect of surgery. Key words Myeloma; spine; diagnosis; surgical treatment; percutaneous spinal biopsy guided by CT 7

5% 1, 2,3,4 (plasma cell dyscrasia) B 1 2 1 2 8

3 4 5 6 7 8 9 1 2 3 4 5 6 9

7 8 9 10 11 Multiple Myeloma,MM M M 6 2 3.1/10 5 1/10 62 7 40 70 50 70 75% 40 2% 8 1983 1984 68 70 9 : 1.6:1 3:1 1983 1984 MM 2.8/10 2.1/10 8 10

30% 10 11,12 1 1cm 2 M Bence Jones protein, B J 11

M 1 1845 William Macintyre 13 Dr Henry Bence Jones Macintyre 1873 Rustizky MM 14 1900 Wright 1939 Longsworth MM monoclonal component 1953 Grabar Williams M 2 MM B 12

IgG IgA IgM IgD IgE γ α µ δ ε κ λ 6000 3 99%MM 15 30g/L MM MM IgG 60% IgA 30% IgD IgE * * IgM MM 13

MM 0.5g/dL 10 10 10 10 MM 1 3 16 MM 70% 90% 2 17 10% 2 20% 5 12 14

3 MM 10% 18 MRI 10% 27% 4 MM 62% 12g/dL 19 20 5 40% 70% 2 20% 6 B 21 15

50% 30% 22 7 1/4 3mmol/L M 8 50% 70% IgA IgD 75% 10% 1 16