Evaluation of the relevance of surgery in patients with multiple myeloma harboring symptomatic spinal involvement: a retrospective case series.

Evaluation of the relevance of surgery in patients with multiple myeloma harboring symptomatic spinal involvement: a retrospective case series.

World Neurosurg. 2018 Mar 09;:

Authors: Quidet M, Zairi F, Boyle E, Facon T, Vieillard MH, Machuron F, Lejeune JP, Assaker R

Abstract
INTRODUCTION: Multiple myeloma spinal involvement can lead to bone-fractures and neurological impairment that can severely alter quality of life. The role of surgery is controversial, given its high morbidity, and the lack of evidence. We hereby aim to evaluate efficacy and safety of surgery in the management of symptomatic spinal lesions in patients with multiple myeloma.
METHODS: We included all patients operated on for a myeloma-related spinal lesion, in our institution between 2007 and 2015. Demographical, clinical and surgical data were collected as well as haematological profiles. We retrospectively assessed the « Surgical Success »of the procedures, if at three months, the patient fulfilled the following four criteria: pain relief, ability to walk, spinal stability and no relevant morbidity.
RESULTS: Thirty-six men and 19 women, with a median age of 62, were included. Seventeen patients underwent an emergency intervention, whereas thirty-eight patients underwent elective surgery. At 3 months, respectively 88.2% and 96.1% of patient experienced pain relief and were able to walk. Spinal stability was considered satisfactory for 94.1% of patients. We reported eight major complications in eight patients. Altogether, 34 patients (61.8%) fulfilled all criteria for "surgical success". ISS 1 and the absence of prior chemotherapy were significantly associated with "surgical success".
CONCLUSION: Management of myeloma-related spine lesions requires a truly multidisciplinary approach. Surgery rapidly provides both decompression and stabilization. Using a strict patient-specific evaluation, we reported rewarding functional results, with acceptable morbidity. Surgery for multiple myeloma vertebral lesions seems to be a valuable option, for carefully selected patients.

PMID: 29530691 [PubMed - as supplied by publisher]

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