Grandpa wang suffered from backache recently. After going to the hospital for examination, he found a big tumor on his spine. What kind of tumor targets the bone? What effect does this tumor have after it invades the bone? What should we do about it? Today, we're going to unearth multiple myeloma, the most common primary tumor of the spine.
What are the common symptoms of multiple myeloma?
Bone pain is the most common initial symptom of multiple myeloma. Multiple myeloma can produce osteolytic lesions in the bone, and about 70% of patients experience significant pain at the site of the lesion. Bone pain is more than the body of the spine, skull, ribs, bone proximal end. As the lesion develops, it leads to pathological fracture, and patients usually have symptoms of local pain. About 8-10% of patients will result in compression of the spinal cord and nerves due to pathological fracture of the spine or growth of solid tumors, as well as neurological impairment, defecation and urination disorders and even paraplegia. Therefore, a series of clinical complications, such as pathological fracture, spinal cord and nerve root compression, osteoporosis, hypercalcemia and bone pain, are called multiple myeloma osteopathy.
Currently, effective hematologic treatment and health guidance have enabled more than half of myeloma patients with lysotic disease to live longer than 5 years. But these treatments are still not effective in curing bone lesions. Patients who have been diagnosed with multiple myeloma are at risk of fracture and related events even if they are treated as planned. Broken bones, paralysis and other events bring physical pain, a diminished quality of life, and the risk of surgery and death.
So how do orthopedic surgeons diagnose multiple myeloma?
A complete diagnosis of osteopathy usually requires a clear history of multiple myeloma, typical clinical manifestations of osteopathy, and appropriate imaging results. Patients with multiple myeloma who have been diagnosed in the hematology department, the diagnosis process is relatively simple. For patients with bone pain, pathological fracture, bone destruction, nerve compression and soft tissue mass first diagnosed in the orthopedic department, the orthopedic doctor will confirm the diagnosis of multiple myeloma through the detection of immunoglobulin in bone marrow, blood and urine. Next, the orthopedic surgeon performs x-rays, ct, mri, and even pet/ct to determine the extent of the lesion, tumor cell proliferation activity, and compression of the spinal cord and nerve roots. When necessary, the orthopedic surgeon will cooperate with the hematologist to select the appropriate site for the first biopsy to confirm the diagnosis.
What circumstance needs orthopedic operation to intervene?
The current view is that surgical intervention is only an auxiliary way to treat multiple myeloma. The purpose of the surgery is not to eradicate multiple myeloma, but to improve the quality of life of patients and create conditions for continuing radiotherapy and chemotherapy. At present, domestic experts generally believe that the following conditions can be treated by surgery: 1. Multiple myeloma combined with spinal instability or pathological fracture; 2. 2. Multiple myeloma spinal lesions compress the spinal cord and nerve roots, resulting in progressive impairment of nerve function; 3. The location of intractable pain was clear and consistent with the location of multiple myeloma osteopathy; Pathologic or potential pathologic fractures of the extremities: 5. Puncture or open biopsy to provide pathological diagnosis. However, if the patient is in poor general condition, unable to tolerate surgery, or heart, lung and renal failure cannot be controlled, or severe coagulation dysfunction cannot be corrected, or severe infection cannot be controlled, surgical treatment is not appropriate. At the same time, patients should be subjected to rigorous evaluation by a hematologist prior to surgical treatment, and prognosis should be assessed with reference to staging and risk stratification (expected survival time > 3 months). The latest evidence-based medicine view holds that surgery should be performed as soon as possible when paraplegia or pathologic fracture of long bone develops rapidly in a short period of time. In other cases, it is recommended to first receive more than one course of systemic hematology-led treatment before assessing the need for surgery.
How do orthopedic surgeons intervene in multiple myeloma?
Orthopedic surgeons generally select the appropriate type of surgery according to the tumor growth site and carry out targeted surgery to create conditions for the follow-up treatment of patients. Depending on the lesion site, surgery generally includes minimally invasive vertebroplasty (PVP/PKP) of the spine, open resection of the tumor, decompression, and internal fixation. Excision or curettage of the long bones of the extremities and pelvis and cementing of the bone; Artificial femoral head replacement for pathologic fracture of femoral neck; Partial sacral or total sacral resection of the sacrum. If continuity is involved in the destruction of bone, local continuity reconstruction is required. In addition to multiple myeloma caused by systemic spread of neoplastic plasma cells, there are two other types of plasma cell tumors. These include extramedullary plasmacytomas of soft tissue and solitary plasmacytomas of bone. Both are locally neoplastic growths of plasma cells, and although they may eventually develop into multiple myeloma, they have the potential to be cured if detected early and excised.
What else should be done after the operation?
In addition to standard chemotherapy, targeted therapy and autologous stem cell transplantation in hematology department, it is also an important part of the treatment of multiple myeloma osteopathy. Patients with creatinine clearance ≥30 ml/min should be treated with bisphosphonates in addition to systemic anti-myeloma therapy. After surgical treatment, in addition to routine hematologic examination, imaging evaluation of the surgical site should be performed regularly. Currently, imaging examination is recommended every 6 to 12 months.
Early detection is the key to the treatment of myeloma. If life is similar to local bone pain old bad symptoms, should be timely to the hospital diagnosis.
This article is scientifically checked by dong jian, director of orthopedics department of zhongshan hospital affiliated to fudan university.
(coordinating editor: intern yu Yang, wang yanhua)