Abstract
BackgroundMultiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures. These are painful, result in kyphosis, and impact respiratory function and quality of life. We explore the impact of time to presentation on the efficacy of spinal treatment modalities.MethodsWe retrospectively reviewed 183 patients with spinal myeloma presenting to our service over a 2 year period.ResultsMedian time from multiple myeloma diagnosis to presentation at our centre was 195 days. Eighty-four patients (45.9 %) were treated with balloon kyphoplasty and the remainder with a thoracolumbar-sacral orthosis as per our published protocol. Patients presenting earlier than 195 days from diagnosis had significant improvements in patient reported outcome measures: EuroQol 5-Dimensions (p < 0.001), Oswestry Disability Index (p < 0.001), and Visual Analogue Pain Score (p < 0.001) at follow-up, regardless of treatment. Patients presenting after 195 days, however, only experienced benefit following balloon kyphoplasty, with no significant benefit from non-operative management.ConclusionVertebral augmentation and thoracolumbar bracing improve patient reported outcome scores in patients with spinal myeloma. However, delay in treatment negatively impacts clinical outcome, particularly if managed non-operatively. It is important to screen and treat patients with MM and back pain early to prevent deformity and improve quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2495-7) contains supplementary material, which is available to authorized users.
Highlights
Multiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures
In multiple myeloma (MM), osteolytic disease in the spine is common as the high hematopoietic marrow content of the vertebrae offers an attractive site for localisation and growth of neoplastic plasma cells [1, 2]
We describe the clinical and radiographic parameters of patients with an established diagnosis of MM presenting to our tertiary referral spinal service, and their response to treatment for their vertebral compression fracture (VCF)
Summary
Multiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures. These are painful, result in kyphosis, and impact respiratory function and quality of life. Augmentation of a fractured vertebral body with acrylic cement has been shown to restore its strength and prevent further kyphosis [11,12,13] This augmentation can be performed using minimally invasive techniques such as percutaneous vertebroplasty or balloon kyphoplasty (BKP). Both techniques have been shown to significantly reduce pain from VCFs and improve function in patients with metastatic disease and myeloma [14,15,16,17]. Functional outcome is important in patients with MM as the life expectancy of this patient cohort continues to increase with the introduction of modern chemotherapeutic treatment regimens [2]
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