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

Abstract

To investigate the feasibility of one-stage total spondylectomy by anterior and posterior approaches for treating solitary plasmacytoma (SP) of cervical spine. 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. 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. 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.