Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Multiple myeloma is the most common primary tumor of the spine and is the most common primary malignant tumor of bone. Although spinal myeloma is classically a radiosensitive lesion, clinical or radiographic signs of instability merit surgical intervention. The authors present the epidemiology, surgical indications, and outcome data of a series of consecutive cases involving 31 surgically treated patients with diagnoses of multiple myeloma and plasmacytoma of the spine (the largest such series reported to date).</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Surgical instability was the criterion for operative intervention in this patient cohort. The Spinal Instability Neoplastic Score (SINS) was used to make this assessment of instability. The cases were analyzed using location of the lesion, spinal levels involved, Frankel score, adjuvant therapy, functional outcome, and patient survival.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>All patients undergoing surgical intervention were determined to have indeterminate or gross spinal column instability according to SINS criteria. The median survival was 78.9 months. No significant difference in survival was seen for patients with higher SINS scores or for older patients (&gt; 55 years). There was a statistically significant difference in survival benefit observed for patients receiving chemotherapy and radiation versus radiation alone as an adjuvant to surgery (p = 0.02).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In this 10-year analysis, the authors report outcomes of surgical intervention for patients with indeterminate or gross spinal instability due to multiple myeloma and plasmacytoma of the spine with improved neurological function following surgery and low rates of instrumentation failure.</jats:p></jats:sec>

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

“…1,13,14,16,17,26,27,30,31,38,63,93,[95][96][97][98] However, surgical approaches to spinal tumors often necessitate extensive reconstruction of the spinal column and may require adjuvant chemotherapy or radiation; therefore, perioperative complication rates after spinal tumor surgery are higher than in other spinal operations. [34][35][36][46][47][48]50,52,65,67,68,78,80,81,[86][87][88]95,100 It is especially important to understand the incidence and predictive factors for adverse events in spinal oncology patients, as a single complication may be associated with morbidity, mortality, and costs. 1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, …”

Morphometrics predicts overall survival in patients with multiple myeloma spine metastasis: A retrospective cohort study

“…Spine surgery in this population has been shown to have the potential to improve patient outcomes,[2132053] but choosing the appropriate patient to take to surgery remains difficult given how current prognostic scores inaccurately estimate survival. [1333453]…”

“…[49444851] A randomized control trial of patients with metastatic spinal cancer with epidural compression showed that the surgical treatment is superior to radiotherapy alone;[38] the efficacy of surgery has been confirmed independently in the myeloma literature. [2132053] Spinal metastasis scoring systems have been developed[17304950] due to an increasing focus on the outcomes after metastatic surgery,[67243141] however, they have consistently underestimated overall survival (OS) in patients with MM. [1333453] Consequently, surgical decision making for this population is challenging.…”

“…[2132053] Spinal metastasis scoring systems have been developed[17304950] due to an increasing focus on the outcomes after metastatic surgery,[67243141] however, they have consistently underestimated overall survival (OS) in patients with MM. [1333453] Consequently, surgical decision making for this population is challenging. Despite surgery improving OS, neurological outcome, and pain control, oncologic spine surgery is resource intensive and has been reported to delay adjuvant chemotherapy and radiotherapy.…”

Comparative analysis of the surgical treatment results for multiple myeloma bone disease of the spine and the long bone/soft tissue

“…In earlier reports, the overall survival time in metastatic bone disease ranged between 6 and 22 months (28,29), depending on the type of primary tumor. Recent studies concluded that the median survival time of MM patients is longer as compared with that of patients with bone metastases (24,30). This explains the fact that, in myeloma patients requiring orthopedic surgery, a treatment decision should be made comprising a stable reconstruction of the bone defects.…”