Evaluation of the Relevance of Surgery in Patients with Multiple Myeloma Harboring Symptomatic Spinal Involvement: A Retrospective Case Series

Quidet, Mathilde; Zaïri, Fahed; Boyle, Eileen M.; Facon, Thierry; Vieillard, Marie-Hélène; Machuron, François; Lejeune, Jean‐Paul; Assaker, R.

doi:10.1016/j.wneu.2018.02.184

Cited by 4 publications

(8 citation statements)

References 52 publications

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“…Because of the dearth of the literature, indications for surgery in MM patients with SIS remain debatable, and clear standards for surgical treatments are yet to be established. 9,23,27 Conventionally, patients with SIS are treated with RT in conjunction with AMD. 4,18 Surgical management is rarely indicated in these patients, as the MM lesions are highly sensitive to RT and AMD.…”

Section: Discussionmentioning

confidence: 99%

“…3 Spinal involvement is common and affects approximately 70% of MM patients, 4,5 thereby rendering it the most frequent primary cancer of the adult spine. 6,7 The development of progressive and destructive osteolytic bone lesions 1,[8][9][10] may lead to pathological fractures, which are present in .50% of all myeloma patients, 11 further leading to spinal instability. 8,12,13 Moreover, epidural involvement due to tumor mass or spinal instability implies a high risk of neurological compromise.…”

Section: Introductionmentioning

confidence: 99%

“…25 There is corroborative evidence in the literature that surgical management of MM leads to significant improvements in patients' neurological status 6,16,26,27 and quality of life. 6,24,28 However, the definite role of possible local treatments, such as vertebroplasty/kyphoplasty, RT, 9 or open/minimally invasive surgery, in the management of myeloma-related spinal lesions remains unclear. 9,27 Furthermore, in patients without neurological compromise, the role of surgery is debateable.…”

Section: Introductionmentioning

confidence: 99%

“…6,24,28 However, the definite role of possible local treatments, such as vertebroplasty/kyphoplasty, RT, 9 or open/minimally invasive surgery, in the management of myeloma-related spinal lesions remains unclear. 9,27 Furthermore, in patients without neurological compromise, the role of surgery is debateable. 9 It is vital to ensure that the benefits of surgical management prevail over its perils since these patients are highly susceptible to infections and exhibit poor bone quality.…”

Section: Introductionmentioning

confidence: 99%

“…9,27 Furthermore, in patients without neurological compromise, the role of surgery is debateable. 9 It is vital to ensure that the benefits of surgical management prevail over its perils since these patients are highly susceptible to infections and exhibit poor bone quality. [29][30][31] In our study, we aimed to investigate clinical presentation, main indications leading to surgery, functional outcomes, complications (3 months postoperatively), and factors influencing neurological deterioration (during hospital stay), infective complications, and overall survival (OS) of MM patients with symptomatic involvement of the spine (SIS) in our population.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine

et al. 2020

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Introduction: Multiple myeloma (MM) is the most frequent primary malignancy of the spine. We aimed to investigate the clinical presentation, surgical indications and outcomes, complications, survival, and its influencing factors in surgically treated MM patients with symptomatic involvement of the spine (SIS). Methods: Retrospective analysis of prospectively collected data. Out of 350 MM patients treated at our institution over a period of 12 years (2006-2018), we identified 24 patients who were surgically treated for SIS. A retrospective analysis of prospectively collected data on demographics, clinical presentation, comorbidities, surgical indications, and outcomes was done, and we investigated the factors predisposing to postoperative complications and survival. Results: The median follow-up duration was 85 months; median overall survival (OS) was 50 months. Clinical presentation at admission included pain (88%), sensory and/or motor deficit (67%), and bowel/bladder dysfunction (25%). Symptomatic pathological fractures were seen in 33%. Predominant surgical indications were rapid neurological deterioration with or without spinal cord compression (SCC), followed by mechanical instability. The majority of our patients benefited from surgery in terms of pain reduction in the short term as well as in the long term. There were 21% patients with surgical-related complications (,3 months). Surgical site infections occurred in 17%, without any obvious factors predisposing to infective complications. Neurological deterioration during hospital stay, especially in the presence of motor deficit and/or bowel/bladder dysfunction, significantly reduced OS. Conclusions: Sudden-onset neurological deterioration had led predominantly to surgery. We have achieved good short-and long-term pain reduction. Surgery is a valuable option for MM patients with SIS who present with rapid neurological deterioration with or without SCC and/or mechanical instability.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine

et al. 2020

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Analysis of the efficacy of separation surgery for severe neurological compression in multiple myeloma: a retrospective analysis of 35 cases

Liu,

Yao,

et al. 2024

Eur Spine J

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Vertebral multiple myeloma with pathological fracture: the most common etiology for emergency spine surgery in patients with no cancer diagnosis on admission

Burks

Elarjani

Jamshidi

et al. 2021

Neurosurgical Focus

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OBJECTIVE Vertebral compression fractures are common in multiple myeloma (MM). Modern treatment paradigms place emphasis on treatment with radiation, with surgery reserved for cases involving frank instability or severe neural compression. However, experience at the authors’ institution has led them to suspect a more prominent role for surgical intervention in some settings. The authors undertook the present study to better understand the incidence of MM in undiagnosed patients who require urgent surgery for pathological vertebral fracture. METHODS The authors reviewed a prospectively collected database of all patients who underwent surgery with the senior author at their main hospital between June 1, 1998, and June 30, 2020. Patients admitted from the emergency room or after transfer from another hospital who then underwent surgery for pathological fracture during the same admission were included in the final analysis. Patients scheduled for elective surgery and those with previous cancer diagnoses were excluded. RESULTS Forty-three patients were identified as having undergone urgent surgical decompression and/or stabilization for pathological fracture. Histopathology confirmed diagnosis of MM in 22 (51%) patients, lung metastasis in 5 (12%) patients, and breast metastasis in 4 (9%) patients. Twelve (28%) patients were diagnosed with other types of metastatic carcinoma or undifferentiated disease. Sixteen of 29 (55%) men and 6 of 14 (42%) women were diagnosed with MM (p = 0.02). Seventeen of 34 (50%) patients who underwent surgery for neurological deficit, 5 of 6 (83%) patients who underwent surgery for spinal instability, and 0 (0%) patients who underwent surgery for pain with impending spinal cord injury were diagnosed with MM (p = 0.12). CONCLUSIONS A majority of patients presenting to the authors’ hospital with no history of malignancy who required urgent surgery for pathological compression fracture were found to have MM or plasmacytoma. This disease process may affect a significant portion of patients requiring decompressive or stabilizing surgery for compression fracture in academic medical centers.

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Evaluation of the Relevance of Surgery in Patients with Multiple Myeloma Harboring Symptomatic Spinal Involvement: A Retrospective Case Series

Cited by 4 publications

References 52 publications

Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine

Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine

Analysis of the efficacy of separation surgery for severe neurological compression in multiple myeloma: a retrospective analysis of 35 cases

Vertebral multiple myeloma with pathological fracture: the most common etiology for emergency spine surgery in patients with no cancer diagnosis on admission

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