Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine

Abstract

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.

Positive outcome of nonoperative management of spinal cord compression by multiple myeloma: A case report

“…[ 1 , 6 ] However, chemotherapy has demonstrated its effectiveness in MM patients with SCC. [ 4 , 5 ] Chemotherapy treatment lead disrupts the interaction with the bone microenvironment, thus inhibiting the osteoclastogenic effect and reducing inflammatory phenomena. Some authors recommend chemotherapy for SCC before surgery.…”

“…Some authors recommend chemotherapy for SCC before surgery. [ 4 , 5 ] There is no consensus on the management of SCC in patients with MM. The therapeutic attitude is discussed on a case-by-case basis.…”

“…It is crucial to avoid instrumentation in chemotherapy patients who are getting stem cell transplants because they run a high risk of developing a secondary infection of the metal. [ 2 , 3 , 4 ] Thus, for our patient, we adopted a conservative treatment with the positioning of a neck brace.…”

Mieloma Múltiplo (Parte 2) - Atualização sobre a Abordagem da Doença Óssea

“…O MM é a neoplasia maligna mais frequente da coluna vertebral, 27 representando aproximadamente 15% de todos os casos. 2 Cerca de 70% dos portadores de MM apresentam lesões na coluna, 18 que constitui o sítio mais frequente para fraturas 1 (> 50%) 27 -8 a 10% dos pacientes desenvolvem déficits neurológicos. 2,12,27 A indicação cirúrgica baseia-se no quadro decisório neurológico, oncológico, mecânico e sistêmico (NOMS), que inclui estado neurológico (mielopatia, grau de compressão medular peridural), radio/quimio-sensibilidade do tumor, instabilidade mecânica, extensão da doença sistêmica e comorbidades.…”

“…2 Cerca de 70% dos portadores de MM apresentam lesões na coluna, 18 que constitui o sítio mais frequente para fraturas 1 (> 50%) 27 -8 a 10% dos pacientes desenvolvem déficits neurológicos. 2,12,27 A indicação cirúrgica baseia-se no quadro decisório neurológico, oncológico, mecânico e sistêmico (NOMS), que inclui estado neurológico (mielopatia, grau de compressão medular peridural), radio/quimio-sensibilidade do tumor, instabilidade mecânica, extensão da doença sistêmica e comorbidades. 28 Vertebroplastia e cifoplastia estão indicadas nos portadores de lesões líticas 3 e/ou fraturas vertebrais compressivas sintomáticas 8 não associadas à compressão medular.…”