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

Category	Detail
Condition	Multiple Myeloma with vertebral column lesions
Key Mechanisms	Plasma cell malignancy causing bone lesions leading to fractures, pain, neurological deficits; bone fragility and immunocompromise complicate surgical decisions
Target Population	Adult patients (≥18 years) with symptomatic vertebral lesions due to Multiple Myeloma
Care Setting	Tertiary academic spine centers with interdisciplinary teams including spine surgery, hematology, oncology, and radio-oncology

80% of MM patients develop bone complications; 50% involve vertebral lesions causing fractures, pain, and neurological risks
Non-surgical management predominates due to MM sensitivity to radio- and chemotherapy and high surgical infection risk
Surgical intervention considered when non-surgical treatment fails, especially for spinal instability or neurological deficits

Use ICD-10 codes C90 (Multiple Myeloma) and C79 (vertebral column lesion) for patient identification
Assess vertebral lesions with CT and MRI imaging
Evaluate spinal stability using Spinal Instability Neoplastic Score (SINS)
Assess neurological and ambulatory status with modified McCormick Scale

Predominantly non-surgical treatment including radio- and chemotherapy for vertebral lesions
Minimally invasive cement augmentation for persistent vertebral pain to reduce pain and improve independence
Surgical approaches (posterior instrumentation, fusion, decompression) reserved for spinal instability, neurological deficits, or failure of conservative treatment

Regular follow-up with clinical and imaging assessments to monitor lesion progression and neurological status
Use ECOG, Karnofsky (KPS), and ASA scores to assess patient functional status during treatment
Monitor for complications post-surgery and neurological outcomes

Adult MM patients with symptomatic vertebral lesions treated between 2005 and 2023 at European tertiary centers

Interdisciplinary treatment decisions vary; lack of standardized surgical guidelines leads to variability in timing and indications for surgery

Employ interdisciplinary teams for comprehensive management of MM vertebral lesions
Use standardized scoring systems (SINS, Bilsky, McCormick) to guide treatment decisions
Prioritize non-surgical treatments initially due to MM radiosensitivity and infection risks
Consider minimally invasive cement augmentation for pain relief when conservative treatment fails
Reserve surgical intervention for spinal instability, neurological deficits, or refractory symptoms
Collect and analyze multicenter data to inform future evidence-based guidelines

Clinical Scorecard: Variability in Surgical Indications, Timing, and Outcomes for Vertebral Lesions in Multiple Myeloma Patients: Findings from the European M2Spine Study Group