Preliminary establishment of a spinal stability scoring system for multiple myeloma

Abstract

BACKGROUND Multiple myeloma is an incurable malignant plasma cell disorder that represents the most common primary malignant bone tumor. It commonly involves bone metastasis in multiple vertebral bodies, and the Spinal Instability Neoplastic Score scoring system may not be fully applicable to multiple myeloma (MM) patients. AIM To evaluate the spinal stability of patients with MM spinal involvement to guide their clinical treatment. METHODS By using the Delphi method, we collected and extracted information through a series of questionnaires and improved it via feedback. We also preliminarily established a spinal stability scoring system for multiple myeloma. RESULTS Fifteen clinicians completed a second round of questionnaires and compared their answers with those of the first round of questionnaires to identify significant comments or changes that required group discussions. As a result, no further feedback was used to improve the scoring system. After integrating the information from the expert consultation questionnaire, we established the initial scoring system for MM spine stability and used the scoring system to assess a series of representative clinical cases. The MM spinal stability scoring system was created by calculating the scores of the six separate components: location, pain, number of segments, physiological curvature, comorbidities, and neurological function. The minimum value was “0”, and the maximum value was “24”. A score of “0–10” indicated “spine stability”, a score of “11–17” indicated “potential instability”, and a score of “18–24” indicated “spine instability”. Patients with a score of “11–24” need an intervention such as surgery. CONCLUSION The initial establishment of the MM spine stability scoring system provides a vital theoretical basis for the evaluation of spine stability in individuals with MM.

A precision‐based exercise program for patients with multiple myeloma

“…Established scoring systems alone might not capture the full extent of bone changes in myeloma patients. 29,30 Specifically, the following aspects are not considered in scoring systems, but commonly occur in myeloma patients and should therefore be taken into account before recommending physical activity.…”

“…Since multiple myeloma is a complex and heterogenous disease, evaluation of bone stability and recommendations on physical exercise require an interdisciplinary setting. Established scoring systems alone might not capture the full extent of bone changes in myeloma patients 29,30 . Specifically, the following aspects are not considered in scoring systems, but commonly occur in myeloma patients and should therefore be taken into account before recommending physical activity.…”

“…[27][28][29] However, it has been previously mentioned that these scoring systems may not be fully applicable to myeloma patients, because several characteristic features of the disease are not included, for example, osteoporosis. 29,30 Additionally, the main objective of these scores is to guide decisionmaking concerning the need for surgical intervention. So far, there are no clear guidelines available that determine the level of physical exercise that can be safely performed by myeloma patients with stable and unstable bone lesions.…”

“…There are several well‐established classification systems available to evaluate bone stability and risk of fracture in cancer patients (i.e., Mirels' score, Taneichi score, Spinal Instability Neoplastic Score) 27–29 . However, it has been previously mentioned that these scoring systems may not be fully applicable to myeloma patients, because several characteristic features of the disease are not included, for example, osteoporosis 29,30 . Additionally, the main objective of these scores is to guide decision‐making concerning the need for surgical intervention.…”