Azmi Tufan, Burak Eren, Ilker Gulec, Murat Karacan, Feyza Karagoz Guzey, Nuri Serdar Bas, Ece Saglam

Omurilik Basısı Nedeniyle Dekompresyon Uygulanan Multipl Miyelom Olgularının Deg erlendirilmesi

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. Anahtar Kelimeler: Multipl miyelom, spinal tümör, omurilik basısı, dekompresyon.

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

Multiple myeloma accounts for 5-10% of all cancers associated with spinal cord compression. In this study, the surgicalresults 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 wasmultiple myeloma in our hospital's neurosurgery clinic included in the study. Demographic, clinical and radiological features of thepatients and their status after surgery were examined. The mean age of the 21 patients was 62.6 ± 9.3. Thirteen patients were maleand 8 were female. When the chain isotype was found in protein electrophoresis, the maximum IgG (52.4%) was present. The meanKarnofsky performance of the patients was 46.2 ± 17.7. Significant improvement was observed in the postoperative motor strengthof the patients (p = 0.0001). In addition, postoperative pain-VAS scores-was significantly reduced (p = 0.0001). 90% of the patientswere 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 themean shrinkage rate of the tumor was 65.4%. Although spinal canal narrowing was observed in all patients, compression fracturewas present in 16 patients (76.2%). The mean follow-up period was 22.3 months. During the follow-up period, 9 patients died, 5 ofthem were in the first year. Postoperative complications were wound infection in 2 patients, chronic renal failure in 1 patient andbilateral pleural effusion in 1 patient. Surgical treatment should be the first option if there is a progressive neurological deficit inpatients with spinal cord compression due to multiple myeloma. With surgical treatment, decompression of the spinal cordcompression, pain control and stabilization can be performed.

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