RT Journal Article
SR Electronic
T1 Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 7112
DO 10.14444/7112
A1 Helena, Milavec
A1 Nivetha, Ravikumar
A1 Nicholas, Syn Li-Xun
A1 Yentia, Soekojo Cinnie
A1 Joo, Chng Wee
A1 Naresh, Kumar
YR 2020
UL https://www.ijssurgery.com/content/early/2020/10/21/7112.abstract
AB 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.