title: The relationship between spinopelvic measurements and patient-reported outcome scores in patients with multiple myeloma of the spine.
abstract: OBJECTIVE
  Patients with multiple myeloma (MM) develop deposits in the spine which may lead to vertebral compression fractures (VCFs). Our aim was to establish which spinopelvic parameters are associated with the greatest disability in patients with spinal myeloma and VCFs.
  
  
  METHODS
  We performed a retrospective cross-sectional review of 148 consecutive patients (87 male, 61 female) with spinal myeloma and analysed correlations between spinopelvic parameters and patient-reported outcome scores. The mean age of the patients was 65.5 years (37 to 91) and the mean number of vertebrae involved was 3.7 (1 to 15).
  
  
  RESULTS
  The thoracolumbar region was most commonly affected (109 patients, 73.6%), and was the site of most posterior vertebral wall defects (47 patients, 31.8%). Poorer Oswestry Disability Index scores correlated with an increased sagittal vertical axis (p = 0.006), an increased number of VCFs (p = 0.035) and sternal involvement (p = 0.012). Poorer EuroQol visual analogue scale scores correlated with posterior vertebral wall defects in the thoracolumbar region (p = 0.012). The sagittal vertical axis increased with the number of fractures and kyphosis in the thoracolumbar (p = 0.009) and lumbar (p < 0.001) regions.
  
  
  CONCLUSIONS
  In MM, patients with VCFs have poorer clinical scores at presentation in the presence of sagittal imbalance. Outcome is particularly affected by multiple fractures in the thoracolumbar and lumbar regions and by failure to prevent kyphosis. Patients with MM should be screened for spinal lesions early. Cite this article: Bone Joint J 2016;98-B:1234-9.
authors: The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, China.
authors: H M
authors: HM
authors: Yu
authors: Royal National Orthopaedic Hospital, Spinal Deformity Unit, Department of Spinal Surgery, Brockley Hill, Stanmore, HA7 4LP, UK.
authors: K
authors: K
authors: Malhotra
authors: Royal National Orthopaedic Hospital, Spinal Deformity Unit, Department of Spinal Surgery, Brockley Hill, Stanmore, HA7 4LP, UK.
authors: J S
authors: JS
authors: Butler
authors: Royal National Orthopaedic Hospital, Spinal Deformity Unit, Department of Spinal Surgery, Brockley Hill, Stanmore, HA7 4LP, UK.
authors: A
authors: A
authors: Patel
authors: Royal National Orthopaedic Hospital, Spinal Deformity Unit, Department of Spinal Surgery, Brockley Hill, Stanmore, HA7 4LP, UK.
authors: M D
authors: MD
authors: Sewell
authors: The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, China.
authors: Y Z
authors: YZ
authors: Li
authors: Royal National Orthopaedic Hospital, Spinal Deformity Unit, Department of Spinal Surgery, Brockley Hill, Stanmore, HA7 4LP, UK.
authors: S
authors: S
authors: Molloy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D050815:Fractures, Compression / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000071066:Patient Reported Outcome Measures; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D015996:Survival Rate; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery
keywords: Multiple myeloma; Outcome scores; Sagittal balance; Spinopelvic parameters; Vertebral fracture