Myeloma- Cord Decompression Surgery

“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.”

My introduction to multiple myeloma, cord compression surgery, went well. According to all the research linked below, surgery to your spine is a well-tolerated, effective multiple myeloma therapy.

Keep in mind that when I went under the knife in early February of 1994, I had no idea what the growth was that had eaten away my fifth cervical vertebra. A diagnosis of incurable blood cancer did not cross the mind of an otherwise physically-fit 34 year old.

Also keep in mind that none of the multiple myeloma therapies that followed- radiation, chemotherapy, an autologous stem cell transplant-none of them went well.

Though the cord compression surgery to my neck did cause mild long-term side effects, the problems were mild. And it was the local radiation that cause the MM side effect called dysphagia aka difficulty swallowing, and not the surgery.

The main point of this post is to apply my personal experience to confirm the research below.

In the final months of 1993, I was experiencing pain and motor weakness. In fact, it was the increasing pain that forced me to go to one of those outpatient clinics to x-ray my neck. Oddly, the M.D. at the clinic was as perplexed by the mass on the x-ray as I was…

I was scheduled for immediate surgery and was under the knife in days. Long story short, as I said, my neck pain resolved in the weeks following my surgery. Yes, once I self-diagnosed my dysphagia, I have been exercising daily to maintain my ability to swallow.

I did not lose height,
I decompressed or straightened out my spinal cord,
I do not experience any residual pain at the surgery site and
my only real reminder of this multiple myeloma therapy is a radiation tattoo that the radiation technician made to insure she hit the same spot during my daily radiation doses.

I wish I could contribute personal experience about the other spinal procedure that is chosen by MM patients- vertebroplasty- kyphoblasty but I cannot. I will say that I’ve read studies about the procedure and talked to cancer patients who have undergone the procedure and all sources attest to the benefits of cementoplasty.

To summarize, if you are a mm patient with a mm lesion in your spine and you are trying to decide between surgery or kyphoplasty, the research says that both procedures will benefit you.

If you would like to ask me anything at all about my own spinal surgery experience, scroll down the page, post a question or comment and I will reply to you ASAP.

Thanks and hang in there,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Recommended Reading:

Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression.

Metastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on patient quality of life in the form of mean quality-adjusted life years (QALY) gained and identify factors associated with positive outcomes…

A total of 151 patients were included in this study (mean age 60.4 years, 57.6% males). The 5 most common metastatic tumor types were lung, multiple myeloma, renal, breast, and prostate cancer. The majority of patients had radioresistant tumors (82.7%) and had an active primary site at presentation (67.5%). The median time from tumor diagnosis to cord compression was 12 months and the median time from identification of cord compression to death was 4 months.

Preoperative presenting symptoms included motor weakness (70.8%), pain (70.1%), sensory disturbances (47.6%), and bowel or bladder disturbance (31.1%)…

At follow-up, 58.3% of patients had improved status, 31.5% had no improvement, and 10.0% had worsening of functional status.

The mean QALY gained per year in the entire cohort was 0.55. The mean QALY gained in the first 6 months was 0.1 and in the first year was 0.4. For patients who lived 1-2, 2-3, 3-4, or 4-5 years, the mean QALY gained were 0.8, 1.4, 1.7, and 2.3, respectively.

Preoperative motor weakness, bowel dysfunction, bladder dysfunction, and ASA (American Society of Anesthesiologists) class were identified as independent predictors inversely associated with good outcome.

The mean QALY gained from surgical decompression in the first 6 months and first year equals 1.2 months and 5 months of life in perfect health, respectively. These findings suggest that surgery might also be beneficial to patients with life expectancy < 6 months.

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

“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…

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.

Kyphoplasty for patients with multiple myeloma is a safe surgical procedure: results from a large patient cohort.

INTRODUCTION: Only in recent years has balloon kyphoplasty gained significance in the treatment of vertebral fractures as an adequate minimally invasive vertebral stabilization technique. Kyphoplasty has also increasingly been used to treat vertebral osteolyses caused by multiple myeloma (MM).

PATIENTS AND METHODS: In our cohort of 76 patients with MM with a total of 190 vertebral fractures treated with kyphoplasty, we performed a 30-day postoperative analysis of cement leakage, neurologic symptoms, pulmonary embolism, and infections.

RESULTS: Painful osteolytic or fractured vertebrae or even imminent vertebral instability caused by osteolyses were seen as indications for kyphoplasty. One case of pulmonary embolism was observed because of cement leakage as the only postoperative complication.

CONCLUSION: By careful interdisciplinary indication setting and a standardized treatment model, kyphoplasty presents a very safe and effective procedure for the treatment of vertebral osteolyses and fractures caused by MM.

Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission

Myeloma- Cord Decompression Surgery

“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.”

Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression.

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

Kyphoplasty for patients with multiple myeloma is a safe surgical procedure: results from a large patient cohort.

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