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. 2018 Oct 15;12(5):571-581.
doi: 10.14444/5070. eCollection 2018 Oct.

Evaluating Treatment Strategies for Spinal Lesions in Multiple Myeloma: A Review of the Literature

Manan Sunil Patel  1 , Alexander Ghasem  2 , Dylan N Greif  1 , Samuel R Huntley  1 , Sheila A Conway  2 , Motasem Al Maaieh  2
Affiliations

Evaluating Treatment Strategies for Spinal Lesions in Multiple Myeloma: A Review of the Literature

Manan Sunil Patel et al. Int J Spine Surg. .

Abstract

Background: Vertebral disease is a major cause of morbidity in 70% of patients diagnosed with multiple myeloma (MM). Associated osteolytic lesions and vertebral fractures are well documented in causing debilitating pain, functional restrictions, spinal deformity, and cord compression. Currently, treatment modalities for refractory MM spinal pain include systemic therapy, radiotherapy, cementoplasty (vertebroplasty/kyphoplasty), and radio frequency ablation. Our objectives were to report on the efficacy of existing treatments for MM patients with refractory spinal pain, to determine if a standardized treatment algorithm has been described, and to set the foundation upon which future prospective studies can be designed.

Methods: A systematic search of the PubMed database was performed for studies relevant to the treatment of vertebral disease in MM patients. A multitude of search terms in various combinations were used, including but not limited to: "vertebroplasty," "kyphoplasty," "radiation," "multiple myeloma," "radiotherapy," and "radiosurgery."

Results: Our preliminary search resulted in 219 articles, which subsequently resulted in 19 papers following abstract, title, full-text, and bibliography review. These papers were then grouped by treatment modality: radiotherapy, cementoplasty, or combination therapy. Significant pain and functional score improvement across all treatment modalities was found in the majority of the literature. While complications of treatment occurred, few were noted to be clinically significant.

Conclusions: Treatment options-radiotherapy and/or cementoplasty-for vertebral lesions and pathologic fractures in MM patients demonstrate significant radiographic and clinical improvement. However, there is no consensus in the literature as to the optimal treatment modality as a result of a limited number of studies reporting head-to-head comparisons. One study did find significantly improved pain and functional scores with preserved vertebral height in favor of kyphoplasty over radiotherapy. When not contraindicated, we advocate for some form of cementoplasty. Further prospective studies are required before implementation of a standardized treatment protocol.

Level of evidence: 5.

Keywords: cementoplasty; combination therapy; kyphoplasty; multiple myeloma; pathologic fracture; radiation; radio frequency ablation; radiosurgery; radiotherapy; vertebral height; vertebroplasty.

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Conflict of interest statement

Disclosures and COI: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Literature review flowchart.
See this image and copyright information in PMC

References

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