title: Surgery for plasma cell neoplasia patients with spinal instability or neurological impairment caused by spinal lesions as the first clinical manifestation.
abstract: OBJECTIVE
  Multiple myeloma (MM) and solitary plasmacytoma of bone (SPB) are two independent subtypes of plasma cell dyscrasias which often occur in spine. However, little is known about the surgical treatment of patients with spinal instability or neurological impairment caused by spinal lesions as the first clinical manifestation. The present study aimed to investigate the surgical outcome of these patients.
  
  
  METHODS
  We retrospectively reviewed the data of a total of 64 patients receiving spinal surgery in our center, in which 30 were diagnosed as MM and 34 as SPB. Univariate and multivariate analyses were used to identify factors associated with overall survival (OS) and progression-free survival (PFS) of patients.
  
  
  RESULTS
  Surgical treatment led to favorable results including pain relief, resumption of ambulatory ability as well as improvement of neurological function and life quality. Univariate analysis suggested that the potential prognostic factors for OS of MM patients were bisphosphonate treatment, post-surgical ambulatory status, Karnofsky Performance Score (KPS) and Frankel scale, and for PFS of MM patients were age at surgery, resection mode, postoperative ambulation status, KPS and Frankel scale, while the PFS of SPB patients was only significantly related to postoperative adjuvant therapies. Multivariate analysis indicated that postoperative ambulation status was the only independent risk factor for both OS and PFS of MM patients.
  
  
  CONCLUSIONS
  Surgery may be beneficial to patients with spinal instability or neurological impairment caused by spinal lesions as the first clinical manifestation, in which MM patients with postoperative ambulatory ability display better prognosis.
authors.affiliation: Spine Tumor Center, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
authors.forename: Weiluo
authors.initials: W
authors.lastname: Cai
authors.forename: Wangjun
authors.initials: W
authors.lastname: Yan
authors.forename: Quan
authors.initials: Q
authors.lastname: Huang
authors.forename: Wending
authors.initials: W
authors.lastname: Huang
authors.forename: Huabin
authors.initials: H
authors.lastname: Yin
authors.forename: Jianru
authors.initials: J
authors.lastname: Xiao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology*; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000601:surgery*; D009422:Nervous System Diseases / Q000209:etiology*; D010954:Plasmacytoma / Q000150:complications / Q000601:surgery*; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000150:complications / Q000601:surgery*; D013131:Spine / Q000601:surgery; D016896:Treatment Outcome