Applications of one-stage total spondylectomy by anterior and posterior approaches for solitary plasmacytoma of cervical spine_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Minhao ,  CAI Lin , YAN Feifei , XU Keke , SUN Wenchao , DENG Zhouming , XIE Yuanlong

Musculoskeletal Tumor and Spinal Central of Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China;

Corresponding author：

CAI Lin, Email: orthopedics@whu.edu.cn

Keywords：

Solitary plasmacytoma; cervical spine; total spondylectomy; anterior and posterior approaches

DOI：

10.7507/1002-1892.201709107

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ObjectiveTo investigate the feasibility of one-stage total spondylectomy by anterior and posterior approaches for treating solitary plasmacytoma (SP) of cervical spine.MethodsBetween 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 C₂ segment, 4 cases in C₃, 2 cases in C₄, 1 recurrent case in C₅, C₆, and 3 cases in C₇. 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.ResultsThe 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 C₅, C₆ 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.ConclusionFor 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.

Citation： WU Minhao, CAI Lin, YAN Feifei, XU Keke, SUN Wenchao, DENG Zhouming, XIE Yuanlong. Applications of one-stage total spondylectomy by anterior and posterior approaches for solitary plasmacytoma of cervical spine. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 195-202. doi: 10.7507/1002-1892.201709107 Copy

1.	Grammatico S, Scalzulli E, Petrucci MT. Solitary Plasmacytoma. Mediterr J Hematol Infect Dis, 2017, 9(1): e2017052.
2.	Huang W, Cao D, Ma J, et al. Solitary plasmacytoma of cervical spine: treatment and prognosis in patients with neurological lesions and spinal instability. Spine (Phila Pa 1976), 2010, 35(8): 278-284.
3.	Barlogie B, Kyle RA, Anderson KC, et al. Standard chemotherapy compared with high-dose chemoradiotherapy for multiple myeloma: final results of phase Ⅲ US Intergroup Trial S9321. J Clin Oncol, 2006, 24(6): 929-936.
4.	Thumallapally N, Meshref A, Mousa M, et al. Erratum to: Solitary plasmacytoma: population-based analysis of survival trends and effect of various treatment modalities in the USA. BMC Cancer, 2017, 17(1): 443.
5.	de Waal EG, Leene M, Veeger N, et al. Progression of a solitary plasmacytoma to multiple myeloma. A population‐based registry of the northern Netherlands. Br J Haematol, 2016, 175(4): 661-667.
6.	Harousseau J, Dreyling M. ESMO Guidelines Working Group. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v155-157.
7.	钱明, 孔金海, 钟南哲, 等. 一期前后联合入路全脊椎切除术治疗枢椎孤立性浆细胞瘤. 脊柱外科杂志, 2017, 15(2): 100-105.
8.	Hsieh PC, Gallia GL, Sciubba DM, et al. En bloc excisions of chordomas in the cervical spine: review of five consecutive cases with more than 4-year follow-up. Spine (Phila Pa 1976), 2011, 36(24): E1581-1587.
9.	黄稳定, 冯大鹏, 肖建如, 等. 颈椎孤立性浆细胞瘤的外科干预及放疗结果分析. 中华外科杂志, 2010, 48(9): 697-701.
10.	Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976), 1997, 22(9): 1036-1044.
11.	张景峰, 王跃. WHO骨肿瘤分类第四版: 解读与比较. 中华骨科杂志, 2015, 35(9): 975-980.
12.	Ozsahin M, Tsang RW, Poortmans P, et al. Outcomes and patterns of failure in solitary plasmacytoma: a multicenter Rare Cancer Network study of 258 patients. Int J Radiat Oncol Biol Phys, 2006, 64(1): 210-217.
13.	von der Hoeh NH, Tschoeke SK, Gulow J, et al. Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature. Eur Spine J, 2014, 23(1): 35-39.
14.	Knobel D, Zouhair A, Tsang RW, et al. Prognostic factors in solitary plasmacytoma of the bone: a multicenter Rare Cancer Network study. BMC Cancer, 2006, 6: 118.
15.	Yang JS, Cho YJ, Kang SH, et al. Rapid progression of solitary plasmacytoma to multiple myeloma in lumbar vertebra. J Korean Neurosurg Soc, 2013, 54(5): 426-430.
16.	Suh YG, Suh CO, Kim JS, et al. Radiotherapy for solitary plasmacytoma of bone and soft tissue: outcomes and prognostic factors. Ann Hematol, 2012, 91(11): 1785-1793.
17.	Kawahara N, Tomita K, Murakami H, et al. Total en bloc spondylectomy of the lower lumbar spine: a surgical techniques of combined posterior-anterior approach. Spine (Phila Pa 1976), 2011, 36(1): 74-82.
18.	Peng CW, Chou BT, Bendo JA, et al. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J, 2009, 9(1): 70-76.
19.	Abumi K, Kaneda K, Shono Y, et al. One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg, 1999, 90(1 Suppl): 19-26.
20.	Magerl F, Coscia MF. Total posterior vertebrectomy of the thoracic or lumbar spine. Clin Orthop Relat Res, 1988, (232): 62-69.
21.	Tomita K, Kawahara N, Baba H, et al. Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. New York: Springer, 2003: 324-33.
22.	Tsutsumi S, Yasumoto Y, Ito M. Solitary spinal extradural plasmacytoma: a case report and literature review. Clin Neuroradiol, 2013, 23(1): 5-9.
23.	Tosi P. Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement. Scientifica (Cairo), 2013, 2013: 104546.
24.	Mirzashahi B, Mazoochy H, Jamnani RK, et al. Contribution of surgery in solitary plasmacytoma of spine; a case report. Arch Bone Jt Surg, 2014, 2(2): 121-125.
25.	Yang X, Wu Z, Xiao J, et al. Chondrosarcomas of the cervical and cervicothoracic spine: surgical management and long-term clinical outcome. J Spinal Disord Tech, 2012, 25(1): 1-9.
26.	Lunardini DJ, Eskander MS, Even JL, et al. Vertebral artery injuries in cervical spine surgery. Spine J, 2014, 14(8): 1520-1525.
27.	Molinari R, Bessette M, Raich AL, et al. Vertebral artery anomaly and injury in spinal surgery. Evid Based Spine Care J, 2014, 5(1):16-27.
28.	Lis E, Bilsky MH, Pisinski L, et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol, 2004, 25(9): 1583-1588.
29.	Ghogawala Z, Mansfiels FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976), 2001, 26(7): 818-824.

1. Grammatico S, Scalzulli E, Petrucci MT. Solitary Plasmacytoma. Mediterr J Hematol Infect Dis, 2017, 9(1): e2017052.
2. Huang W, Cao D, Ma J, et al. Solitary plasmacytoma of cervical spine: treatment and prognosis in patients with neurological lesions and spinal instability. Spine (Phila Pa 1976), 2010, 35(8): 278-284.
3. Barlogie B, Kyle RA, Anderson KC, et al. Standard chemotherapy compared with high-dose chemoradiotherapy for multiple myeloma: final results of phase Ⅲ US Intergroup Trial S9321. J Clin Oncol, 2006, 24(6): 929-936.
4. Thumallapally N, Meshref A, Mousa M, et al. Erratum to: Solitary plasmacytoma: population-based analysis of survival trends and effect of various treatment modalities in the USA. BMC Cancer, 2017, 17(1): 443.
5. de Waal EG, Leene M, Veeger N, et al. Progression of a solitary plasmacytoma to multiple myeloma. A population‐based registry of the northern Netherlands. Br J Haematol, 2016, 175(4): 661-667.
6. Harousseau J, Dreyling M. ESMO Guidelines Working Group. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5: v155-157.
7. 钱明, 孔金海, 钟南哲, 等. 一期前后联合入路全脊椎切除术治疗枢椎孤立性浆细胞瘤. 脊柱外科杂志, 2017, 15(2): 100-105.
8. Hsieh PC, Gallia GL, Sciubba DM, et al. En bloc excisions of chordomas in the cervical spine: review of five consecutive cases with more than 4-year follow-up. Spine (Phila Pa 1976), 2011, 36(24): E1581-1587.
9. 黄稳定, 冯大鹏, 肖建如, 等. 颈椎孤立性浆细胞瘤的外科干预及放疗结果分析. 中华外科杂志, 2010, 48(9): 697-701.
10. Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976), 1997, 22(9): 1036-1044.
11. 张景峰, 王跃. WHO骨肿瘤分类第四版: 解读与比较. 中华骨科杂志, 2015, 35(9): 975-980.
12. Ozsahin M, Tsang RW, Poortmans P, et al. Outcomes and patterns of failure in solitary plasmacytoma: a multicenter Rare Cancer Network study of 258 patients. Int J Radiat Oncol Biol Phys, 2006, 64(1): 210-217.
13. von der Hoeh NH, Tschoeke SK, Gulow J, et al. Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature. Eur Spine J, 2014, 23(1): 35-39.
14. Knobel D, Zouhair A, Tsang RW, et al. Prognostic factors in solitary plasmacytoma of the bone: a multicenter Rare Cancer Network study. BMC Cancer, 2006, 6: 118.
15. Yang JS, Cho YJ, Kang SH, et al. Rapid progression of solitary plasmacytoma to multiple myeloma in lumbar vertebra. J Korean Neurosurg Soc, 2013, 54(5): 426-430.
16. Suh YG, Suh CO, Kim JS, et al. Radiotherapy for solitary plasmacytoma of bone and soft tissue: outcomes and prognostic factors. Ann Hematol, 2012, 91(11): 1785-1793.
17. Kawahara N, Tomita K, Murakami H, et al. Total en bloc spondylectomy of the lower lumbar spine: a surgical techniques of combined posterior-anterior approach. Spine (Phila Pa 1976), 2011, 36(1): 74-82.
18. Peng CW, Chou BT, Bendo JA, et al. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J, 2009, 9(1): 70-76.
19. Abumi K, Kaneda K, Shono Y, et al. One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg, 1999, 90(1 Suppl): 19-26.
20. Magerl F, Coscia MF. Total posterior vertebrectomy of the thoracic or lumbar spine. Clin Orthop Relat Res, 1988, (232): 62-69.
21. Tomita K, Kawahara N, Baba H, et al. Total en bloc spondylectomy. A new surgical technique for primary malignant vertebral tumors. New York: Springer, 2003: 324-33.
22. Tsutsumi S, Yasumoto Y, Ito M. Solitary spinal extradural plasmacytoma: a case report and literature review. Clin Neuroradiol, 2013, 23(1): 5-9.
23. Tosi P. Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement. Scientifica (Cairo), 2013, 2013: 104546.
24. Mirzashahi B, Mazoochy H, Jamnani RK, et al. Contribution of surgery in solitary plasmacytoma of spine; a case report. Arch Bone Jt Surg, 2014, 2(2): 121-125.
25. Yang X, Wu Z, Xiao J, et al. Chondrosarcomas of the cervical and cervicothoracic spine: surgical management and long-term clinical outcome. J Spinal Disord Tech, 2012, 25(1): 1-9.
26. Lunardini DJ, Eskander MS, Even JL, et al. Vertebral artery injuries in cervical spine surgery. Spine J, 2014, 14(8): 1520-1525.
27. Molinari R, Bessette M, Raich AL, et al. Vertebral artery anomaly and injury in spinal surgery. Evid Based Spine Care J, 2014, 5(1):16-27.
28. Lis E, Bilsky MH, Pisinski L, et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol, 2004, 25(9): 1583-1588.
29. Ghogawala Z, Mansfiels FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976), 2001, 26(7): 818-824.

Chinese Journal of Reparative and Reconstructive Surgery

Applications of one-stage total spondylectomy by anterior and posterior approaches for solitary plasmacytoma of cervical spine

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