RT Journal Article
SR Electronic
T1 Evaluating Treatment Strategies for Spinal Lesions in Multiple Myeloma: A Review of the Literature
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 571
OP 581
DO 10.14444/5070
VO 12
IS 5
A1 PATEL, MANAN SUNIL
A1 GHASEM, ALEXANDER
A1 GREIF, DYLAN N.
A1 HUNTLEY, SAMUEL R.
A1 CONWAY, SHEILA A.
A1 AL MAAIEH, MOTASEM
YR 2018
UL https://www.ijssurgery.com/content/12/5/571.abstract
AB Background: Vertebral disease is a major cause of morbidity in 70% of patients diagnosed with multiple myeloma (MM). Associated osteolytic lesions and vertebral fractures are well documented in causing debilitating pain, functional restrictions, spinal deformity, and cord compression. Currently, treatment modalities for refractory MM spinal pain include systemic therapy, radiotherapy, cementoplasty (vertebroplasty/kyphoplasty), and radio frequency ablation. Our objectives were to report on the efficacy of existing treatments for MM patients with refractory spinal pain, to determine if a standardized treatment algorithm has been described, and to set the foundation upon which future prospective studies can be designed.Methods: A systematic search of the PubMed database was performed for studies relevant to the treatment of vertebral disease in MM patients. A multitude of search terms in various combinations were used, including but not limited to: “vertebroplasty,” “kyphoplasty,” “radiation,” “multiple myeloma,” “radiotherapy,” and “radiosurgery.”Results: Our preliminary search resulted in 219 articles, which subsequently resulted in 19 papers following abstract, title, full-text, and bibliography review. These papers were then grouped by treatment modality: radiotherapy, cementoplasty, or combination therapy. Significant pain and functional score improvement across all treatment modalities was found in the majority of the literature. While complications of treatment occurred, few were noted to be clinically significant.Conclusions: Treatment options—radiotherapy and/or cementoplasty—for vertebral lesions and pathologic fractures in MM patients demonstrate significant radiographic and clinical improvement. However, there is no consensus in the literature as to the optimal treatment modality as a result of a limited number of studies reporting head-to-head comparisons. One study did find significantly improved pain and functional scores with preserved vertebral height in favor of kyphoplasty over radiotherapy. When not contraindicated, we advocate for some form of cementoplasty. Further prospective studies are required before implementation of a standardized treatment protocol.Level of Evidence: 5.