J Korean Neurosurg Soc.  2022 Mar;65(2):287-296. 10.3340/jkns.2021.0199.

Unstable Pathologic Vertebral Fractures in Multiple Myeloma : Propensity Score Matched Cohort Study between Reconstructive Surgery with Adjuvant Radiotherapy and Radiotherapy Alone

• Park HY
• Kim YH
• Ahn JH
• Ha KY
• Kim SI
• Jung JW

• KMID: 2527185
• DOI: http://doi.org/10.3340/jkns.2021.0199

Abstract

Objective
: Although radiotherapy (RT) is recommended for multiple myeloma (MM) involving spine, the treatment of choice between reconstructive surgery with RT and RT alone for pathologic vertebral fractures (PVFs) associated with structural instability or neurologic compromises remains controversial. The purpose of this study was to evaluate the clinical efficacies of reconstructive surgery with adjuvant RT for treatment of MM with PVFs by comparing with matched cohorts treated with RT alone.
Methods
: Twenty-eight patients underwent reconstructive surgery followed by RT between 2008 and 2015 in a single institution, for management of PVFs associated with structural instability of the spine and/or neurologic compromises (group I). Twentyeight patients were treated with RT alone (group II) after propensity score matching in a 1-to-1 format based on instability of the spine, as well as age and performance. Clinical outcomes including the overall survival rates, duration of independent ambulation, neurological status, and numeric rating scale (NRS) for back pain were compared.
Results
: Clinical and radiological features before treatment were similar in both groups. The median survival period was similar between the two groups. However, the mean duration of independent ambulation was significantly longer in group I (88.8 months; 95% confidence interval [CI], 66.0–111.5) than in group II (39.4 months; 95% CI, 25.2–53.6) (log rank test; p=0.022). Deterioration of Frankel grade (21.4% vs. 60.7%, p=0.024) and NRS for back pain (2.7±2.2 vs. 5.0±2.7, p=0.000) at the last follow-up were higher in the group II. Treatment-related complications were similar in both groups.
Conclusion
: In patients with unstable PVFs due to MM, reconstructive surgery may yield superior clinical outcomes compared with RT alone in maintaining independent ambulation and neurological status, as well as pain control despite similar median survival and complications.

Keyword

Spine; Multiple myeloma; Surgery; Radiotherapy

Figure

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  Fig. 1. Flow chart of patients included in the propensity score-matched cohort study. ECOG : Eastern Cooperative Oncology Group.

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  Fig. 2. A 72-year-old female patient undergoing reconstructive surgery for pathologic vertebral fracture due to multiple myeloma. A : Preoperative radiograph and (B) magnetic resonance imaging reveal a C4 pathologic fracture (de novo kyphosis) with epidural extension. C : Postoperative radiograph revealing anterior corpectomy with plate fixation and laminectomy with posterior screw fixation.

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  Fig. 3. Cumulative rates of independent ambulation in the two groups. RT : radiotherapy.

Reference

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