title: Spinal disease in myeloma: cohort analysis at a specialist spinal surgery centre indicates benefit of early surgical augmentation or bracing.
abstract: Multiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures. These are painful, result in kyphosis, and impact respiratory function and quality of life. We explore the impact of time to presentation on the efficacy of spinal treatment modalities.
  
  
  
  We retrospectively reviewed 183 patients with spinal myeloma presenting to our service over a 2 year period.
  
  
  
  Median time from multiple myeloma diagnosis to presentation at our centre was 195 days. Eighty-four patients (45.9 %) were treated with balloon kyphoplasty and the remainder with a thoracolumbar-sacral orthosis as per our published protocol. Patients presenting earlier than 195 days from diagnosis had significant improvements in patient reported outcome measures: EuroQol 5-Dimensions (p < 0.001), Oswestry Disability Index (p < 0.001), and Visual Analogue Pain Score (p < 0.001) at follow-up, regardless of treatment. Patients presenting after 195 days, however, only experienced benefit following balloon kyphoplasty, with no significant benefit from non-operative management.
  
  
  
  Vertebral augmentation and thoracolumbar bracing improve patient reported outcome scores in patients with spinal myeloma. However, delay in treatment negatively impacts clinical outcome, particularly if managed non-operatively. It is important to screen and treat patients with MM and back pain early to prevent deformity and improve quality of life.
authors.affiliation: Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK. karan@doctors.org.uk.
authors.forename: Karan
authors.initials: K
authors.lastname: Malhotra
authors.affiliation: Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Butler
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, People's Republic of China.
authors.forename: Hai Ming
authors.initials: HM
authors.lastname: Yu
authors.affiliation: Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
authors.forename: Susanne
authors.initials: S
authors.lastname: Selvadurai
authors.affiliation: Department of Clinical Haematology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
authors.forename: Shirley
authors.initials: S
authors.lastname: D'Sa
authors.affiliation: Department of Clinical Haematology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Rabin
authors.affiliation: Department of Clinical Haematology, The Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: Charalampia
authors.initials: C
authors.lastname: Kyriakou
authors.affiliation: Department of Clinical Haematology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK.
authors.forename: Kwee
authors.initials: K
authors.lastname: Yong
authors.affiliation: Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Molloy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001915:Braces; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D058498:Kyphoplasty; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications*; D010014:Osteolysis / Q000209:etiology; D059408:Pain Management / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Multiple myeloma; Outcome scores; Thoracolumbar bracing; Vertebral augmentation; Vertebral fracture