title: Optimizing the management of patients with spinal myeloma disease.
abstract: 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. This article reviews the treatment and management options for spinal myeloma disease and highlights the value of defined pathways to enable the proper management of patients affected by it.
authors.affiliation: Royal National Orthopaedic Hospital, London, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Molloy
authors.affiliation: Myeloma UK, Edinburgh, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Lai
authors.affiliation: Department of Haematology, Heart of England NHS Trust Foundation, Birmingham, UK.
authors.forename: Guy
authors.initials: G
authors.lastname: Pratt
authors.affiliation: Department of Haematology, Oxford University Hospitals NHS Trusts, Oxford, UK.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramasamy
authors.affiliation: St Luke's Radiology, St Luke's Hospital, Oxford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK.
authors.forename: Nasir
authors.initials: N
authors.lastname: Quraishi
authors.affiliation: Department of Haematology, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Auger
authors.affiliation: Trauma and Orthopaedics Department, Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: David
authors.initials: D
authors.lastname: Cumming
authors.affiliation: Department of Haematology, Lancashire Teaching Hospitals NHS Foundations Trust, Preston, UK.
authors.forename: Maqsood
authors.initials: M
authors.lastname: Punekar
authors.affiliation: Department of Haematology, Belfast City Hospital, Belfast, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Quinn
authors.affiliation: Trauma and Orthopaedics Department, Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: Debo
authors.initials: D
authors.lastname: Ademonkun
authors.affiliation: Department of Haematology, St Georges Hospital, London, UK.
authors.forename: Fenella
authors.initials: F
authors.lastname: Willis
authors.affiliation: Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Tighe
authors.affiliation: St James' Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.affiliation: Royal Orthopaedic Hospital NHS Foundations Trust, Birmingham, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: Stirling
authors.affiliation: Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Bishop
authors.affiliation: Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Williams
authors.affiliation: Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK.
authors.forename: Bronek
authors.initials: B
authors.lastname: Boszczyk
authors.affiliation: Spinal Unit, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Royal Orthopaedic Hospital NHS Foundations Trust, Birmingham, UK.
authors.forename: Mel
authors.initials: M
authors.lastname: Grainger
authors.affiliation: Orthopaedic Suite, Woodend Hospital, Aberdeen, UK.
authors.forename: Niall
authors.initials: N
authors.lastname: Craig
authors.affiliation: Department of Orthopaedic Surgery, Musgrove Park Hospital, Belfast, UK.
authors.forename: Alastair
authors.initials: A
authors.lastname: Hamilton
authors.affiliation: Trauma and Orthopaedics Department, Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: Isobel
authors.initials: I
authors.lastname: Chalmers
authors.affiliation: Academic Unit of Supportive Care, Department of Oncology, University of Sheffield, Sheffield, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Ahmedzai
authors.affiliation: Royal National Orthopaedic Hospital, London, UK.
authors.forename: Susanne
authors.initials: S
authors.lastname: Selvadurai
authors.affiliation: Myeloma UK, Edinburgh, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Low
authors.affiliation: Department of Haematology, Northwick Park Hospital and Department of Haematology and Stem Cell Transplantation, Royal Free Hospital, London, UK.
authors.forename: Charalampia
authors.initials: C
authors.lastname: Kyriakou
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009101:Multiple Myeloma / Q000000981:diagnostic imaging / Q000188:drug therapy; D011859:Radiography; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D004164:Diphosphonates
keywords: diagnosis; management; pathway; spinal myeloma disease; treatment