Role of surgery in the management of Spinal Haematological Malignancies. Single centre experience and review of literature
Mohamed Abdelrahman Abdalla, M Nyanzu, C Fenner, E Fragkakis, B Ajayi, C Lupu, T Bishop, J. Bernard, F
Willis, Y Reyal, E Pereira, M Papadopoulos and M Crocker D Lui
St George’s Hospital, UK
: J Spine Neurosurg
Abstract
Hematological malignancies commonly affect the Spine and can result in pain, neural compression, or instability. Urgent evaluation and treatment are often needed for these conditions to avoid permanent neurological deficit or deformity. However, the best treatment strategies for these spinal tumors are still evolving and subject to ongoing research and improvement. In particular, the role of fixation surgery seems to be declining in favor of other treatment modalities. This study aimed to review the literature for the current trends in the management of spinal involvement in Hematological Diseases. We compared our practice in the spine unit at St George’s Hospital over the past five years to the best available evidence, particularly the guidelines of the British Hematological Group published in 2015. In particular, we reviewed the trend towards surgical intervention in the five years of the study. Method: We underwent a retrospective review of all spinal hematological malignancy patients who were discussed in the spinal MDT and managed in the spine unit at St George’s Hospital in the period between September 2015 and December 2020. We analyzed the demographics of the patients treated in this period and compared the management modalities adopted in the unit to the current scientific shreds of evidence and guidelines especially British Hematological guidelines. Result: A total of 259 spinal hematological patients were referred to the spine MDT in the period between Sep 2015 and Dec 2020. The age range was 41-93. 159 were males (61.38%) and 100 were females. The number of referrals increased significantly in 2020 (69) compared to the precedent years (average 34). This results from the regular attendance of the hematology team in the MDT meetings which began in 2020. A dedicated section for the discussion of the Hematological Spine Disease has been added to the spine proforma accordingly. The Thoracic Spine was the most commonly affected region followed by the Lumbar Spine. The diffuse Spinal Infiltrative Disease was most common in 2020 cases. Similarly, the number of non-spinal cord compression cases (Bilsky 0 or B0) has shown a sharp rise in 2020 (36 cases). B3 cases were the highest in 2016 (14 cases). In 2020, there were 9 cases with a B3 score. The total number of surgical cases was the lowest in 2020 (5 cases: 7.4% % of the total number). The indication for surgical intervention was spinal instability in four cases and the fifth case had surgery for decompression and fixation. In 2016 the percentage was 21.1%. More cases had Balloon Kyphoplasty in 2019 (20.83%) than any previous year.
Biography
Mohamed Abdelrahman Abdalla is a Senior Clinical Fellow in Complex Spine Surgery at St George’s University Hospital. He completed his basic Neurosurgical Training in Egypt and pursued further international experience in KSA and UK. He has done a fellowship in Complex Spine Surgery in Imperial College Health Trust and is finishing another one in St George’s Hospital. He has a special interest in MSCC and deformity surgery and he is heading for another Spinal Fellowship in deformity correction surgery.
