Practice variations in indication, timing and outcome of Multiple Myeloma patients undergoing surgery for vertebral lesions – results from the European M2Spine study group - Report - MDSpire
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Practice variations in indication, timing and outcome of Multiple Myeloma patients undergoing surgery for vertebral lesions – results from the European M2Spine study group
Variability in Surgical Management of Vertebral Lesions in Multiple Myeloma Patients
Overview
This retrospective cohort study of 704 multiple myeloma patients with vertebral lesions highlights significant variability in surgical indications, timing, and outcomes across European centers. It underscores the lack of standardized surgical guidelines and reveals that surgical intervention is often delayed despite symptomatic vertebral instability and neurological deficits.
Background
Multiple myeloma (MM) is a plasma cell malignancy frequently complicated by bone lesions, with vertebral involvement occurring in approximately 50% of cases leading to fractures, pain, and neurological risks. While MM lesions are generally sensitive to chemo- and radiotherapy, surgical intervention remains controversial due to infection risks and compromised bone integrity. Minimally invasive cement augmentation can alleviate pain but does not restore spinal stability or address neurological impairment, often necessitating more extensive surgical procedures. Unlike metastatic spine disease, no standardized surgical scoring or guidelines exist for MM-related vertebral lesions, prompting this multicenter European study to evaluate current surgical practices.
Data Highlights
Parameter
Value/Description
Study Cohort
704 MM patients with vertebral lesions
Centers
7 tertiary academic spine centers in Germany, Austria, Italy
Study Period
2005–2023
Primary Outcomes
Complication rate, neurological outcome
Secondary Outcomes
Conservative treatment failure, delayed surgery factors
80% of MM patients develop bone complications; 50% involve vertebral lesions causing fractures and neurological risks.
Surgical intervention is underutilized due to infection risk and bone fragility, despite some patients having severe symptoms.
Cement augmentation reduces pain but does not restore spinal stability or improve neurological deficits.
Posterior instrumentation and decompression are main surgical approaches but lack standardized indications in MM.
Spinal Instability Neoplastic Score (SINS) was retrospectively applied, revealing many lesions categorized as potentially unstable or unstable.
Significant variability exists in surgical timing and decision-making across centers, highlighting absence of evidence-based guidelines.
Clinical Implications
Clinicians should recognize that while non-surgical management is often preferred, patients with persistent pain, spinal instability, or neurological deficits may benefit from timely surgical intervention. Utilizing standardized scoring systems like SINS could aid in identifying candidates for surgery. Multidisciplinary collaboration is essential to balance surgical risks with potential benefits in this immunocompromised population.
Conclusion
This study reveals considerable heterogeneity in the surgical management of MM-related vertebral lesions and emphasizes the urgent need for evidence-based guidelines to optimize patient outcomes. Incorporating standardized assessment tools may improve surgical decision-making and timing.
References
European M2Spine Study Group 2024 -- Variability in Surgical Indications, Timing, and Outcomes for Vertebral Lesions in Multiple Myeloma Patients
by Vanessa Hubertus, Lennart Viezens, Martin Stangenberg, Anton M. Früh, Hanno S. Meyer, Raimunde Liang, Andreas Kramer, Christoph Orban, Johannes Kerschbaumer, Beate Kunze, Stefano Telera, Hannah Miller, Christian J. Entenmann, Emily J. von Bronewski, Charlotte Buhre, Leon-Gordian Leonhardt, Wolfgang Willenbacher, Irma Kvitsaridze, Dominik Laue, Matthias Pumberger, Theresa Keller, Güliz Acker, Jan Krönke, Igor-Wolfgang Blau, Ulrich Keller, Florian Ringel, Claudius Thomé, Bernhard Meyer, Peter Vajkoczy, Marc Dreimann, Julia Sophie Onken
