Omurilik Basısı Nedeniyle Dekompresyon Uygulanan Multipl Miyelom Olgularının Değerlendirilmesi

Year 2020, Volume: 42 Issue: 5, 546 - 552, 15.09.2020

Burak Eren İlker Güleç Feyza Karagöz Güzey Ece Sağlam Azmi Tufan Murat Karacan Nuri Serdar Baş

https://doi.org/10.20515/otd.571004

Abstract

Multipl miyelom omurilik kompresyonuyla
ilişkili tüm kanserlerin % 5-10’ unu oluşturur. Bu çalışmada spinal epidural
bası nedeniyle opere edilen multipl miyelom olan hastaların cerrahi sonuçlar
değerlendirildi. 2011-2017 yılları arasında hastanemiz nöroşirurji kliniğinde
omurilik basısı nedeniyle posterior girişimle dekompresyon yapılan ve patolojik
tanısı multipl miyelom olan 21 hasta çalışmaya dahil edildi. Hastaların
demografik, klinik ve radyolojik özellikleri incelendi. 21 hastanın yaş
ortalaması 62.6±9,3' tü. Hastaların 13' ü erkek ve 8' i kadındı. Protein
elektroferezinde zincir izotipine bakıldığında en fazla Ig G (%52.4)
bulunuyordu. Hastaların Karnofsky performans değeri ortalama 46.2±17,7 idi.
Hastaların ameliyat öncesine göre postoperatif motor güçlerinde belirgin
iyileşme görüldü (p=0,0001). Ayrıca VAS skorlarına bakıldığında postoperatif
ağrının belirgin olarak azaldığı tespit edildi (p=0,001). Hastaların %90’ ının
acil şartlarda ameliyata alındığı görüldü. Ameliyat sırasında dekompresyona
ilave olarak stabilizasyon yapılan hasta sayısı 5' ti (%23.8). Radyolojik
veriler incelendiğinde opere edilen vertebra segmentindeki ortalama çökme
miktarı oranı %33.1 ve tümörün spinal kanal çapını ortalama daraltma oranı
%65.4 olarak hesaplandı. Tüm hastalarda spinal kanal çapında daralma olmasına
rağmen, çökme kırığı 16 hastada (%76.2) vardı. Ortalama takip süresi 22.3 ay
idi. İlk bir yılda 5 hasta olmak üzere, takip süresinde 9 hasta kaybedildi.
Ameliyat sonrası komplikasyon olarak 2 hastada yara yeri enfeksiyonu, 1 hastada
kronik böbrek yetmezliği ve 1 hastada da bilateral plevral efüzyon gelişti.
Multipl miyelom nedeni ile omurilik basısı olan hastlarda ilerleyici nörolojik
defisit varsa cerrahi tedavi ilk seçenek olmalıdır. Cerrahi tedavi ile omurilik
basısının dekompresyonu, ağrı kontrolü ve stabilizasyonu yapılabilir. 

Keywords

Multipl miyelom, vertebra tümörü, spinal kord basısı, spinal tümör

Supporting Institution

yok

Evaluation of Multiple Myeloma Patients Performed Decompression Due to Spinal Cord Pressure

Abstract

Multiple myeloma accounts for
5-10% of all cancers associated with spinal cord compression. In this study,
the surgical results of patients with multiple myeloma operated for spinal
epidural compression were evaluated. Between 2011 and 2017, twenty-one patients
were operated by posterior decompression for spinal cord compression, whose
pathological diagnosis was multiple myeloma in our hospital's neurosurgery
clinic included in the study. Demographic, clinical and radiological features
of the patients and their status after surgery were examined. The mean age of
the 21 patients was 62.6 ± 9.3. Thirteen patients were male and 8 were female.
When the chain isotype was found in protein electrophoresis, the maximum IgG
(52.4%) was present. The mean Karnofsky performance of the patients was 46.2 ±
17.7. Significant improvement was observed in the postoperative motor strength
of the patients (p = 0.0001). In addition, postoperative pain-VAS scores-was
significantly reduced (p = 0.0001). 90% of the patients were operated under
emergency conditions. The number of patients who were operated stabilization
with decompression was 5 (23.8%). When the radiological data were analyzed, the
mean amount of compression in the operated vertebrae was 33.1% and the mean shrinkage
rate of the tumor was 65.4%. Although spinal canal narrowing was observed in
all patients, compression fracture was present in 16 patients (76.2%). The mean
follow-up period was 22.3 months. During the follow-up period, 9 patients died,
5 of them were in the first year. Postoperative complications were wound
infection in 2 patients, chronic renal failure in 1 patient and bilateral
pleural effusion in 1 patient. Surgical treatment should be the first option if
there is a progressive neurological deficit in patients with spinal cord
compression due to multiple myeloma. With surgical treatment, decompression of
the spinal cord compression, pain control and stabilization can be performed.

Keywords

Multiple myeloma, vertebra tumor, spinal cord compression, spinal tumor

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