Solitary involvement of multiple myeloma in the upper thoracic spine, and anterior approach to thoracic region without full sternotomy: A case report

Yıl 2018, Cilt: 2 Sayı: 3, 403 - 405, 01.09.2018

Mehmet Bülent Önal , Atilla Kırçelli Erdinç Civelek

https://doi.org/10.28982/josam.437453

Öz

Multiple myeloma is cancer that starts in the plasma cells in bone marrow. Bone x- rays may show fractures or hollowed out areas of bone. The most common skeletal sites are pelvis, skull, spine, ribs and femoral and humeral shafts. The unique anatomy of thoracic spine creates challenging surgery approaches. Treatment choices of hematological malignancies of the spine are surgery, chemotherapy and radiotherapy. Unilateral L-shaped manubriotomy does not require full sternotomy for upper thoracic segment pathologies. We present a case of multiple myeloma patient in the upper thoracic area and the surgical management. We present an approach to anterior pathology of the upper thoracic spine that obviates the need for sternotomy.

Anahtar Kelimeler

Multiple myeloma, Unilateral L-shaped manubriotomy, Anterior approach, Cervicothoracic junction

Üst torasik omurgada multipl miyelomun soliter tutulumu ve sternotomi yapılmaksızın torasik bölgeye anterior yaklaşım: Olgu sunumu

Öz

Multipl miyelom kemik iliğindeki plasma hücrelerinden başlayan bir kanser türüdür. Kemik grafileri kemikteki kırıkları ve oyukları gösterebilir. En sık tutulan iskelet alanları pelvis, kafatası, kaburgalar ve femur- humerus kemikleridir. Torasik omurganin özellikli anatomisi, bu bölgenin cerrahi yaklaşımlarını oldukça zorlaştırır. Omurgadaki hematolojik hastalıkların tedavi seçenekleri arasında cerrahi, kemoterapi ve radyoterapi seçenekleri yeralmaktadır. Tek taraflı L- şekilli manubriyotomi sayesinde üst torasik bölge patolojilerine yaklaşımlarda tam sternotomi gerekmemektedir. Üst torasik omur multiple myeloma hastasının cerrahi yönetimini sunmayı amaçladık. Sunulan cerrahi yöntem üst torasik bölgeye yaklaşımda sternotomi ihtiyacını ortadan kaldırmaktadır.

Anahtar Kelimeler

Multipl Miyelom, Tek taraflı L-şekilli manubriyotomi, Anterior yaklaşım, Servikotorasik bileşke

Kaynakça

• 1. Sundaresan N, Shah J, Foley KM, Rosen G. An anterior surgical approach to the upper thoracic vertebrae. J Neurosurg. 1984;61(4):686-90.
• 2. Lall RR, Smith ZA, Wong AP, Miller D, Fessler RG. Minimally invasive thoracic corpectomy: surgical strategies for malignancy, trauma, and complex spinal pathologies. Minim Invasive Surg. 2012;2012:213791.
• 3. Gokaslan ZL, York JE, Walsh GL, McCutcheon IE, Lang FF, Putnam JB Jr, Wildrick DM, Swisher SG, Abi-Said D, Sawaya R. Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg. 1998;89(4):599-609.
• 4. Tamburrelli FC, Proietti L, Scaramuzzo L, De Stefano V, Logroscino CA. Bisphosphonate therapy in multiple myeloma in preventing vertebral collapses: preliminary report. Eur Spine J 21 Suppl. 2012;1:141-5.
• 5. Flouzat-Lachaniette CH, Allain J, Roudot-Thoraval F, Poignard A. Treatment of spinal epidural compression due to hematological malignancies: a single institution's retrospective experience. Eur Spine J (E Pub). 2012;10.
• 6. Tarantino R, Donnarumma P, Marruzzo D, Landi A, Giacomo T, Delfini R. Anterior surgical approaches to the cervicothoracic junction: when to use the manubriotomy? Spine J. 2013 Mar 30. doi:pii: S1529-9430(13)00249-0.
• 7. Donnarumma P, Nigro L, Tarantino R, De Giacomo T, Delfini R. The Manubriotomy is a safe option for the anterior approach to the cervico-thoracic junction. Journal of Spine Surgery. 2017;3(3):426-8.
• 8. Pointillart V, Aurouer N, Gangnet N, Vital JM. Anterior approach to the cervicothoracic junction without sternotomy: a report of 37 cases. Spine. 2007;32(25):2875-9.
• 9. Luk KD, Cheung KM, Leong JC. Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. A report of five cases. J Bone Joint Surg Am. 2002;84(6):1013-7.
• 10. Comey CH, McLaughlin MR, Moossy J. Anterior thoracic corpectomy without sternotomy: a strategy for malignant disease of the upper thoracic spine. Acta Neurochir (Wien). 1997;139(8):712-8.
• 11. Huang Y, Tian N, Chi Y, Wang S, Pan J, Xu H. Mini open anterior approach to the cervicothoracic junction: a cadaveric study. Eur Spinr J. 2013 doi:10.1007/s00586-2766-9.
• 12. Darling GE, McBroom R, Perrin R. Modified anterior approach to the cervico- thoracic junction. Spine. 1995;20:1519-21.