Role of surgery in multiple myeloma involving the spine

This paper examined the role of surgery in multiple myeloma that had affected the spine. The authors concluded that spine surgery benefited certain patients.

Multiple myeloma is a cancer of the plasma cells (type of white blood cell). These plasma cells can grow in the bone, and commonly involves the spine. This increases the risk of fractures and nerve damage. It also can cause a great deal of pain.

Treatment for multiple myeloma is generally chemotherapy. The role of surgery is controversial. Surgery comes with many risks, and there is a lack of evidence to show its benefit. Thus, studies are needed to determine whether surgery can be effective in multiple myeloma affecting the spine.

Information on 55 patients who had surgery for multiple myeloma involving the spine was included in this study. The decision for surgery had been made on a case-by-case basis. 17 patients had an emergency surgery. 38 patients had a planned surgery. 27 patients had surgery because the spinal cord was compressed. 18 patients had surgery because of a fracture. 10 patients had surgery to stabilize and prevent a high-risk fracture.

Before 3 months, 3 patients died from worsening disease and 1 patient died from a complication following surgery. At 3 months, 51 patients were then assessed. 88.2% of these patients had good pain relief. 

No patients had a worse outcome with regards to nerve damage. Of 13 patients who were unable to walk initially, 11 regained the ability to walk. Overall, 96.1% of patients were able to walk.

12 patients had a complication after surgery. 5 of these required another surgery to fix it. There were 3 severe medical complications including kidney failure, heart attack, and lung infection.  85% of patients had a good result overall. The surgical success rate was 61.8% overall. Chemotherapy before surgery was associated with surgical failure, especially when it was done close to surgery.

The authors concluded that spine surgery for multiple myeloma in certain patient can give beneficial results.

Only patients who had been considered suitable for surgery were studied.