Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine

Helena Milavec; Nivetha Ravikumar; Nicholas L Syn; Cinnie Yentia Soekojo; Wee Joo Chng; Naresh Kumar

doi:10.14444/7112

Surgical Management of Multiple Myeloma With Symptomatic Involvement of the Spine

Int J Spine Surg. 2020 Oct;14(5):785-794. doi: 10.14444/7112. Epub 2020 Oct 23.

Authors

Helena Milavec^{1

2}, Nivetha Ravikumar¹, Nicholas L Syn³, Cinnie Yentia Soekojo⁴, Wee Joo Chng⁴, Naresh Kumar¹

Affiliations

¹ Department of Orthopaedic Surgery, National University Health System, Singapore.
² Department of Orthopaedic Surgery and Traumatology, Spine Unit, Inselspital, Bern University Hospital, Bern, Switzerland.
³ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ Department of Haematology-Oncology, National University Health System, Singapore.

PMID: 33097585
PMCID: PMC7671448
DOI: 10.14444/7112

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. We collected data on demographics, clinical presentation, comorbidities, surgical indications, and outcomes and 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 was the predominant factor leading to surgery. We 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.

Keywords: complications; functional outcomes; infections; multiple myeloma; neurologic deficits; overall survival; pain; pathological fractures; spinal cord compression; spine; surgery.