Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Sep;174(3):765-777.
doi: 10.1007/s11060-025-05085-y. Epub 2025 Jun 13.

Practice variations in indication, timing and outcome of Multiple Myeloma patients undergoing surgery for vertebral lesions - results from the European M2Spine study group

Vanessa Hubertus  1   2 , Lennart Viezens  3 , Martin Stangenberg  3 , Anton M Früh  1   2 , Hanno S Meyer  4   5 , Raimunde Liang  5 , Andreas Kramer  6 , Christoph Orban  7 , Johannes Kerschbaumer  7 , Beate Kunze  8 , Stefano Telera  9 , Hannah Miller  1 , Christian J Entenmann  1 , Emily J von Bronewski  1 , Charlotte Buhre  1 , Leon-Gordian Leonhardt  3 , Wolfgang Willenbacher  10 , Irma Kvitsaridze  11 , Dominik Laue  12 , Matthias Pumberger  13 , Theresa Keller  14 , Güliz Acker  1   2   15 , Jan Krönke  16 , Igor-Wolfgang Blau  16 , Ulrich Keller  16 , Florian Ringel  6 , Claudius Thomé  7 , Bernhard Meyer  5 , Peter Vajkoczy  1 , Marc Dreimann  3   8 , Julia Sophie Onken  17   18
Affiliations
Multicenter Study

Practice variations in indication, timing and outcome of Multiple Myeloma patients undergoing surgery for vertebral lesions - results from the European M2Spine study group

Vanessa Hubertus et al. J Neurooncol. 2025 Sep.

Abstract

Purpose: Painful vertebral lesions are pathognomonic in Multiple Myeloma (MM). While non-surgical management is generally preferred, some patients ultimately require surgical intervention. Here we describe the largest European cohort of MM patients with vertebral lesions to examine the practice variations of spine surgery in means of indication, timing and outcome.

Methods: This study included patients with MM vertebral lesions enrolled in the European M2Spine Registry (DRKS00033326) at seven European academic spine centers between 2005 and 2023. Retrospective analysis evaluated epidemiological, clinical, and oncological treatment, focused on surgical management. Uni- and multivariate analyses identified factors associated with a decision towards spine surgery, including transitions from initially intended non-surgical approaches.

Results: 704 patients were enrolled and 493 (70%) surgically treated. Main indications for surgery were refractory vertebral pain (41%) and neurological deficits (22%). Radiological and clinical parameters indicating spinal instability as assessed retrospectively were present in 32% but associated with surgical management in only 43%. 338 patients (48%) underwent surgery during early disease stage, while 110 (16%) received delayed surgery (median: 42 months, range: 12-306 months). Statistical analysis revealed lower MM grading (ISS) at diagnosis (p < 0.001), and a new onset of neurological deficits (p < 0.001) as the most significant indicators for a cross-over from intended non-surgical to surgical treatment. Of the 78% of patients available for neurological follow up, 94% of surgically treated patients showed an improved or stable neurological status after a median of 45 months.

Conclusion: Surgical intervention proved to be a viable option for patients with refractory pain and neurological deficits. Data from future prospective studies are necessary to evaluate the clinical trajectory of surgical and non-surgical treatment, and to ultimately provide evidence-based surgical treatment guidelines for MM patients.

Keywords: Chronic vertebral pain; Multiple myeloma; Surgical complications; Surgical decision-making; Vertebral column lesions.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: Ethical approval was obtained (EA4/063/20). Previous presentations: Parts of this work were presented at the Annual Congress of the German Spine Society (DWG) 2024, Nov 27-29, in Hamburg, Germany. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Overview of study inclusion criteria and study recruitment. Figure created with Biorender.com
Fig. 2
Fig. 2
A Overview of surgical strategies. Abbreviations: CA = Cement augmentation (vertebro-/kyphoplasty), Ant + C = Anterior instrumentation with corpectomy, Post = Posterior instrumentation (MIS = minimal invasive surgery), Post + C = Posterior instrumentation with corpectomy, 360°+C = 360° Anterior-posterior instrumentation with corpectomy. B Overview of the Percentage of patients treated within the surgical groups (CA, Ant/Post including Ant + C, Post and Post + C, 360°+C), and C of the associated surgical complication rates, with ** = p < 0.01. D Surgical strategies stratified by degree of spinal stability. E Influence of spinal stability on applied treatment. * Spinal stability assessed in accordance with Spinal Instability Neoplastic Score (SINS) criteria
Fig. 3
Fig. 3
Swimmer Plot illustration the clinical course and timing of treatment starting from the time of fist diagnosis of MM vertebral lesion to the latest available follow-up or death of the patient, in A for all patients treated with surgery, and in B for all conservatively treated patients. C Forest plot: Odds ratio of factors associated with delayed surgery in MM patients
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Callander NS, Baljevic M, Adekola K et al (2022) NCCN Guidelines® insights: multiple myeloma, version 3.2022. J Natl Compr Canc Netw 20(1):8–19. 10.6004/JNCCN.2022.0002 - PubMed
    1. Edwards CM, Zhuang J, Mundy GR (2008) The pathogenesis of the bone disease of multiple myeloma. Bone 42(6):1007–1013. 10.1016/j.bone.2008.01.027 - PMC - PubMed
    1. Castella M, de Larrea CF, Martín-Antonio B, Immunotherapy (2018) A novel era of promising treatments for multiple myeloma. Int J Mol Sci 19(11). 10.3390/ijms19113613 - PMC - PubMed
    1. Amelot A, Moles A, Cristini J et al (2016) Predictors of survival in patients with surgical spine multiple myeloma metastases. Surg Oncol 25(3):178–183. 10.1016/j.suronc.2016.05.012 - PubMed
    1. Gokaraju K, Butler JS, Benton A, Suarez-Huerta ML, Selvadurai S, Molloy S (2016) Multiple myeloma presenting with acute bony spinal cord compression and mechanical instability successfully managed nonoperatively. Spine J 16(8):e567–e570. 10.1016/j.spinee.2016.03.011 - PubMed

Publication types

LinkOut - more resources