Multiple Myeloma: Surgery of the Spine

STUDY DESIGN: The authors report on the clinical course of 27 consecutive patients surgically treated for solitary or multiple myeloma of the spine. OBJECTIVES: To evaluate the complications, neurologic function, life quality, and survival after decompression of the spinal cord and stabilization of the spinal column in cases of conventionally untreatable pain, neurologic impairment, or spinal instability. SUMMARY OF BACKGROUND DATA: The clinical outcome in patients surgically treated for multiple myeloma of the spine has not been intensively studied. Because patients with myeloma often live longer than patients with bone metastases from other malignancies, it is important that these patients be examined and treated with methods specific to their needs and not only with those typically used for patients with metastatic disease. METHODS: The 27 patients had undergone the following surgical procedures: two dorsal decompressions, seven dorsal decompressions and stabilizations, 15 ventral decompressions and stabilizations, and three ventral and dorsal decompressions and stabilizations. Quality of life was measured by the Karnofsky Index, neurologic impairment according to Frankel, and survival by the Kaplan-Meier method. RESULTS: Life quality improved from 48% before surgery to 59% 1 month after surgery and 73% in 24 survivors after the first year. Comparison of their presurgical scores with the scores obtained 1 month after surgery revealed that 18 patients had improved, five patients stayed the same, and four patients declined. After 1 year the scores of all 24 surviving patients had improved from their presurgical levels. In the 21 patients with unimpaired preoperative neurologic function, one patient developed a paraparesis as a complication of surgery, while 20 remained unimpaired until death or 1 year after treatment. All six patients with neurologic deficits improved, two of them to normal function. Pain relief was evident in 26 cases. The mean length of postoperative survival was 49.7 months. Local tumor recurrence occurred in three of 27 patients (11.1%). CONCLUSION: The surgical treatment of myeloma of the spine seems to be an effective method of treatment with respect to neurologic function and life quality in selected cases.