Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2016

Open Access 01-12-2016 | Research article

Spinal disease in myeloma: cohort analysis at a specialist spinal surgery centre indicates benefit of early surgical augmentation or bracing

Authors: Karan Malhotra, Joseph S. Butler, Hai Ming Yu, Susanne Selvadurai, Shirley D’Sa, Neil Rabin, Charalampia Kyriakou, Kwee Yong, Sean Molloy

Published in: BMC Cancer | Issue 1/2016

Login to get access

Abstract

Background

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. We explore the impact of time to presentation on the efficacy of spinal treatment modalities.

Methods

We retrospectively reviewed 183 patients with spinal myeloma presenting to our service over a 2 year period.

Results

Median 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.

Conclusion

Vertebral 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.
Appendix
Available only for authorised users
Literature
1.
Gerszten PC, Welch WC. Current surgical management of metastatic spinal disease. Oncology (Williston Park). 2000;14(7):1013–24. discussion 24, 29–30.
2.
Tosi P. Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement. Scientifica (Cairo). 2013;2013:104546.
3.
4.
Tosi P, Sintini M, Molinari AL, Imola M, Ciotta G, Tomassetti S, et al. Early application of percutaneous vertebroplasty reduces pain without affecting peripheral blood stem cell (PBSC) collection and transplant in newly diagnosed multiple myeloma (MM) patients. Eur J Cancer Care (Engl). 2014;23(6):773–8.CrossRef
5.
Cho SK, Lee JH, Han M, Lee S, Kim JY, Ryu JA, et al. The influence of vertebral fracture on the functional disability of patients with rheumatoid arthritis. J Korean Med Sci. 2014;29(6):859–63.CrossRefPubMedPubMedCentral
6.
Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P. Consequences of vertebral deformities in older men and women. J Bone Miner Res. 2000;15(8):1564–72.CrossRefPubMed
7.
Harrison RA, Siminoski K, Vethanayagam D, Majumdar SR. Osteoporosis-related kyphosis and impairments in pulmonary function: a systematic review. J Bone Miner Res. 2007;22(3):447–57.CrossRefPubMed
8.
Yang HL, Zhao L, Liu J, Sanford Jr CG, Chen L, Tang T, et al. Changes of pulmonary function for patients with osteoporotic vertebral compression fractures after kyphoplasty. J Spinal Disord Tech. 2007;20(3):221–5.CrossRefPubMed
9.
Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990;141(1):68–71.CrossRefPubMed
10.
Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30(18):2024–9.CrossRef
11.
Molloy S, Mathis JM, Belkoff SM. The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine (Phila Pa 1976). 2003;28(14):1549–54.
12.
Molloy S, Riley 3rd LH, Belkoff SM. Effect of cement volume and placement on mechanical-property restoration resulting from vertebroplasty. AJNR Am J Neuroradiol. 2005;26(2):401–4.PubMed
13.
Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976). 2001;26(14):1511–5.CrossRef
14.
Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225–35.CrossRefPubMed
15.
Anselmetti GC, Manca A, Montemurro F, Hirsch J, Chiara G, Grignani G, et al. Percutaneous vertebroplasty in multiple myeloma: prospective long-term follow-up in 106 consecutive patients. Cardiovasc Intervent Radiol. 2012;35(1):139–45.CrossRefPubMed
16.
Jurczyszyn A, Czepko R, Banach M, Godlewski B, Czepko RA, Maslowski P, et al. Percutaneous Vertebroplasty for Pathological Vertebral Compression Fractures Secondary to Multiple Myeloma--Medium-Term and Long-Term Assessment of Pain Relief and Quality of Life. Adv Clin Exp Med. 2015;24(4):651–6.CrossRefPubMed
17.
McDonald RJ, Trout AT, Gray LA, Dispenzieri A, Thielen KR, Kallmes DF. Vertebroplasty in multiple myeloma: outcomes in a large patient series. AJNR Am J Neuroradiol. 2008;29(4):642–8.CrossRefPubMed
18.
Molloy S, Lai M, Pratt G, Ramasamy K, Wilson D, Quraishi N, et al. Optimizing the management of patients with spinal myeloma disease. Br J Haematol. 2015;171:332–43.CrossRefPubMed
19.
Erkan S, Yercan HS, Okcu G, Ozalp RT. The influence of sagittal cervical profile, gender and age on the thoracic kyphosis. Acta Orthop Belg. 2010;76(5):675–80.PubMed
20.
Vedantam R, Lenke LG, Keeney JA, Bridwell KH. Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults. Spine (Phila Pa 1976). 1998;23(2):211–5.CrossRef
21.
Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am. 2005;87(2):260–7.CrossRefPubMed
22.
Jackson RP, Kanemura T, Kawakami N, Hales C. Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine (Phila Pa 1976). 2000;25(5):575–86.CrossRef
23.
Pickard AS, Neary MP, Cella D. Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes. 2007;5:70.CrossRefPubMedPubMedCentral
24.
Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968–74.CrossRefPubMed
25.
Parker SL, Mendenhall SK, Shau D, Adogwa O, Cheng JS, Anderson WN, et al. Determination of minimum clinically important difference in pain, disability, and quality of life after extension of fusion for adjacent-segment disease. J Neurosurg Spine. 2012;16(1):61–7.CrossRefPubMed
26.
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940–52. discussion 52.CrossRef
27.
Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682–8.CrossRef
28.
Langdon J, Bernard J, Molloy S. Prophylactic stabilization of vertebral body metastasis at risk of imminent fracture using balloon kyphoplasty. Spine (Phila Pa 1976). 2009;34(13):E469–72.CrossRef
29.
Garcia-Maroto R, Garcia-Coiradas J, Milano G, Cebrian JL, Marco F, Lopez-Duran L. Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine. Rev Esp Cir Ortop Traumatol. 2015;59(6):406–12.PubMed
30.
Julka A, Tolhurst SR, Srinivasan RC, Graziano GP. Functional outcomes and height restoration for patients with multiple myeloma-related osteolytic vertebral compression fractures treated with kyphoplasty. J Spinal Disord Tech. 2014;27(6):342–6.CrossRefPubMed
31.
Pflugmacher R, Kandziora F, Schroeder RJ, Melcher I, Haas NP, Klostermann CK. Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up. Acta Radiol. 2006;47(4):369–76.CrossRefPubMed
Metadata
Title
Spinal disease in myeloma: cohort analysis at a specialist spinal surgery centre indicates benefit of early surgical augmentation or bracing
Authors
Karan Malhotra
Joseph S. Butler
Hai Ming Yu
Susanne Selvadurai
Shirley D’Sa
Neil Rabin
Charalampia Kyriakou
Kwee Yong
Sean Molloy
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-2495-7

Other articles of this Issue 1/2016

BMC Cancer 1/2016 Go to the issue

Research article

Predictive factors for a long-term response duration in non-squamous cell lung cancer patients treated with pemetrexed

Research article

Using gene expression from urine sediment to diagnose prostate cancer: development of a new multiplex mRNA urine test and validation of current biomarkers

Research article

Verification of microRNA expression in human endometrial adenocarcinoma

Research article

Vimentin and Ki67 expression in circulating tumour cells derived from castrate-resistant prostate cancer

Research article

Tumor apelin, not serum apelin, is associated with the clinical features and prognosis of gastric cancer

Case report

Herpes simplex virus-1 encephalitis induced by chemoradiotherapy and steroids in an esophageal cancer patient: a case report
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits