Spinal surgery for Myeloma

Overview
In myeloma, bone lesions in the spine can cause vertebral compression fractures that lead to severe pain, deformity, and loss of mobility. In cases where symptoms are not improved with nonsurgical treatments such as radiation therapy or bisphosphonate medications such as Aredia and Zometa, spinal surgery may be used to stabilize the spine, prevent further fractures, restore mobility, and reduce pain.

Low blood count, abnormal bleeding, or infections – all common symptoms of myeloma and common side effects of myeloma treatments – may make some people ineligible for spinal surgery.

What does it involve?
Spinal surgery for myeloma is often minimally invasive and may or may not require overnight admission to a hospital. The procedure may be performed under local or general anesthesia.

There are two main types of surgery for vertebral compression fractures. Both are guided by X-ray imaging and may involve a small incision or a needle only. In vertebroplasty, the surgeon injects a highly specialized cement mixture into the collapsed vertebra. When the cement hardens, the vertebra will be stabilized. Stabilization prevents painful friction, further collapse, and the development of deformity.

Kyphoplasty is similar to vertebroplasty, but with an additional step. The surgeon first inserts a small balloon into the compressed vertebra and inflates it to create space. They then inject the bone cement.

After surgery, you will lie still for about an hour while the cement hardens. You may stay in the hospital for some additional hours for observation, or be admitted overnight. You may need to wear a brace during recovery. Avoid heavy lifting for six weeks after spinal surgery.

Intended outcomes
Spinal surgery can restore stability to fractured vertebrae, prevent further fractures, reduce pain, and return mobility. Kyphoplasty can also help restore height.

Results
In a study involving 55 people who had spinal surgery for multiple myeloma, 45 people reported significant pain relief after the surgery. Before the surgery, 13 of the participants were unable to walk; 11 people regained the ability to walk. Twelve of the participants developed complications after surgery, including five who required additional surgery to address the issue. One patient died as a result of a post-surgical complication. The researchers noticed that chemotherapy before surgery – especially soon before surgery – increased the risk that the surgery would fail.

Constraints
Spinal surgery may not be effective in easing your pain or restoring mobility.

Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery. People with myeloma may have a higher risk for developing some complications than people who do not have cancer.

Rare but serious complications specific to spinal surgery can include spinal cord injury, nerve pain, continued or worsening spine pain, leakage of bone cement into tissues, sexual dysfunction, and damage to the segment of the spine adjacent to the repaired portion.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.

You may require revision surgery if you experience complications from your spinal surgery.

For more details about this treatment, visit:

Surgical intervention in myeloma (PDF) – Myeloma UK
https://www.myeloma.org.uk/wp-content/uploads/2...

Role of surgery in multiple myeloma involving the spine – Medivizor
https://medivizor.com/blog/SampleLibrary/multip...

Kyphoplasty – Johns Hopkins Medicine
https://www.hopkinsmedicine.org/healthlibrary/t...

Vertebroplasty – Johns Hopkins Medicine
https://www.hopkinsmedicine.org/healthlibrary/t...

Vetebroplasty Procedure – Spine-health
https://www.spine-health.com/treatment/back-sur...

Description of Kyphoplasty Surgery – Spine-health
https://www.spine-health.com/treatment/back-sur...

Vertebroplasty & Kyphoplasty – RadiologyInfo.org
https://www.radiologyinfo.org/en/info.cfm?pg=ve...