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Multiple Myeloma Diagnosis- Spine Therapies
“Myeloma is one of the most common malignancies that results in osteolytic lesions of the spine. Complications, including pathological fractures of the vertebrae and spinal cord compression, may cause severe pain, deformity and neurological sequelae.”
Hi David- My dad was diagnosed with multiple myeloma in October this year. My dad is dealing with back pain due to bone involvement in his spine.
He has an option of having an operation on his back. This operation is quite a major operation to put rods in his spine to help with pain.
I was wondering if you have had anything like this. Or any suggestions to help with back pain. Will we ever get normal again?
Great to hear you are doing well after so long, so good to hear. Thanks, Ellen.
Hi Ellen-
I’m sorry to learn of your dad’s MM diagnosis and back issues. I assume that your dad’s back pain is being caused by one or more lesions in his spine?
Yes, while I have no personal experience with rods in my spine, I know of MM patients who have had rods put in the spine to manage pain.
Possible outcomes, or I should say the success of the operation, alleviation of pain, use, flexibility, etc. depends on your dad (age, health, etc.) and the facility you are at- their surgical experience, etc.
Two things for you to consider:
- spine lesions can also be managed with kyphoplasty/vertebroplasty.
- spine lesions can also be managed with local radiation.
All three options- surgery/rods, cement in the spine, local radiation, all have pros and cons, risks and benefits.
I will link and excerpt studied below to provide some research on these possible therapies and I encourage you to get a second and possibly a third opinion.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
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Optimizing the management of patients with spinal myeloma disease
“Myeloma is one of the most common malignancies that results in osteolytic lesions of the spine. Complications, including pathological fractures of the vertebrae and spinal cord compression, may cause severe pain, deformity and neurological sequelae. They may also have significant consequences for quality of life and prognosis for patients. For patients with known or newly diagnosed myeloma presenting with persistent back or radicular pain/weakness, early diagnosis of spinal myeloma disease is therefore essential to treat and prevent further deterioration. Magnetic resonance imaging is the initial imaging modality of choice for the evaluation of spinal disease. Treatment of the underlying malignancy with systemic chemotherapy together with supportive bisphosphonate treatment reduces further vertebral damage.
Additional interventions such as cement augmentation, radiotherapy, or surgery are often necessary to prevent, treat and control spinal complications.
However, optimal management is dependent on the individual nature of the spinal involvement and requires careful assessment and appropriate intervention throughout…
Successful treatment and management of spinal myeloma disease requires a multidisciplinary approach that addresses the following:
- treatment of the myeloma with systemic chemotherapy; adequate control of pain;
- relief of spinal cord or cauda equina compression and maintenance of spinal stability.
To reduce the risk of further spinal bone destruction or permanent deformity/neurological dysfunction and the impact on patient quality of life, it is imperative these measures are addressed in a systematic manner…
Radiotherapy
Myeloma lesions are extraordinarily radiosensitive and for patients with levels of spinal pain that significantly affect day‐to‐day function, radiotherapy can be useful for its control….
Radiotherapy is also indicated for the treatment of epidural or extramedullary masses at risk of, or causing, spinal cord or cauda equina compression.
However, it should be used judiciously as extensive radiotherapy could compromise the bone marrow reserve for future treatment, namely high‐dose therapy and stem cell transplantation…
Surgery
…However, this type of treatment is not always appropriate or indeed possible for myeloma patients because of the often extensive and diffuse nature of the lesions, which severely impairs the strength of the vertebrae.
As a consequence, inserting rods and screws safely can be extremely challenging. Moreover, the majority of patients are poor candidates for invasive surgery because of advanced age and comorbid factors, predisposing them to longer recovery times and increased risk of morbidity and mortality.
Patients are also significantly immunocompromised, both as a result of the disease itself and its treatments, thus risking infection of the inserted metalwork.
In most cases, epidural tumours are treated very effectively by steroids/chemotherapy and radiotherapy, obviating the need for surgical decompression. Therefore, surgical intervention is reserved for those with significant spinal instability, for example, where there has been significant destruction to all three bony columns of the spine (determined by the SINS classification and in concert with the spinal surgeon)…
Vertebral augmentation with cement
Two minimally‐invasive vertebral augmentation techniques, percutaneous vertebroplasty (PV) and balloon kyphoplasty (BKP), have become increasingly common treatments to decrease pain associated with VCFs and restore strength and stiffness to the vertebral bodies
In myeloma patients, vertebral augmentation is indicated for those with significant pain affecting day‐to‐day function as a result of VCF or bone destruction with high risk of collapse…
Reports indicate that the procedure stabilizes the vertebra and provides rapid pain relief…
However, the procedure is not without risk. The cement, when injected, may leak into the blood vessels or the spinal canal, which has been reported to result in cement embolus and neurological dysfunction respectively…
These are rare phenomena but cement leakage into the disc is a relatively common complication, which may create mechanical stress that can result in the fracture of an adjacent vertebral body.
In addition, PV does not correct spinal deformity…