title: Surgical management of spinal fractures and neurological involvement in patients with myeloma.
abstract: BACKGROUND
  Multiple Myeloma (MM) typically involves the spine and causes bone pain, pathological fractures and spinal cord compression with possible consequent neurological deficits. This retrospective study reports the results of surgery on a selected population of patients who underwent surgery for symptomatic spinal myeloma.
  
  
  METHODS
  A total of 26 patients who underwent surgery for spinal myeloma with neurological involvement were studied retrospectively. Neurological evaluation was performed according to the Frankel grade. Characteristics of this population, reconstructive techniques and surgery-related complications were reviewed.
  
  
  RESULTS
  The tumours involved the thoracic spine in 13 patients, the lumbar spine in 10 patients, and the cervical spine in three patients. The most common approach was a posterior-only approach (70%), followed by a staged, combined approach (20%), and an anterior-only approach (10%). The mean postoperative survival time was 43 months (range: 8-60 months). A significant improvement in neurological function was observed in the study population after surgery (p=0.001). There were seven early postoperative complications, two late complications and five surgery-related complications.
  
  
  CONCLUSIONS
  Surgery in selected patients affected by spinal myeloma with neurological involvement is associated with good clinical outcomes and neurological recovery and an acceptable rate of complications. Neurological deficit and segmental instability can be treated sufficiently in most cases by the implementation of a posterior-only approach; however, the final treatment should, when possible, include adjuvant chemotherapy and radiotherapy and rigorous bracing.
authors: Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Italy.
authors: Vincenzo
authors: V
authors: Denaro
authors: Academic Neurosurgery, Department of Neurosurgical Sciences, University of Padova, Italy.
authors: Luca
authors: L
authors: Denaro
authors: Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Italy.
authors: Erika
authors: E
authors: Albo
authors: Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Italy.
authors: Nicola
authors: N
authors: Papapietro
authors: Centro oncologico di palazzo Baleani, Policlinico Umberto I, Rome, Italy.
authors: Andrea
authors: A
authors: Piccioli
authors: Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Italy. Electronic address: dimartino.cbm@gmail.com.
authors: Alberto
authors: A
authors: Di Martino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome
keywords: Chemotherapy; Multiple myeloma; Neurological involvement; Radiotherapy; Spinal surgery; Spine myeloma