Complications After Spine Surgery in Multiple Myeloma With Spinal Involvement

By Patrick Daly - Last Updated: September 19, 2023

In the European Spine Journal, researchers described postoperative complications and revisions and associated risk factors after spine surgery in patients with multiple myeloma (MM) with spinal involvement. They cited that patients with MM suffer from an increased risk of infection and poor bone quality, potentially predisposing them to postoperative complications.

Based on their retrospective analysis, the study’s authors, led by Hester Zijlstra, MD, suggested that rates of postoperative complication were relatively high in patients with MM who underwent spinal surgery, “likely attributable to both inherent characteristics of the disease and patient comorbidities.”

The study enrolled 270 patients with MM who received surgical treatment of MM lesions between 2008 and 2021. The median age of the cohort was 65 ± 10.8 years, and 58% were male (n=57). The primary end points were the incidences of 6-week perioperative complications and 2.5-year reoperations, as well as odds ratios (ORs) for related risk factors.

Factors Associated with Spine Surgery Complications in MM

Records showed intraoperative complications occurred in 24 (8.9%) patients, and the overall 6-week complication rate was 35.0% (n=95). Risk factors associated with increased odds of complications included:

  • Higher Genant grading of present vertebral fracture (OR, 1.41; 95% CI, 1.04-1.95; P=.031)
  • Steroids received in the week prior to surgery (OR, 3.97; 95% CI, 1.79-9.06; P=.001)
  • Decompression surgery without fusion (OR, 6.53; 95% CI, 1.30-36.86; P=.026)
  • Higher serum creatinine levels (OR, 2.18; 95% CI, 1.19-5.60; P=.014)
  • Lower calcium levels (OR, 0.58; 95% CI, 0.37-0.88; P=.013)

A total of 53 (20.0%) patients were indicated for a second surgery, and 13 (4.8%) of these surgeries occurred within 2 weeks of the primary spinal surgery. Adjacent-level fractures were the most commonly reported reason for revision surgery. Researchers noted that both the overall complication rate of 35% and the retreatment rate of 20% may still be underestimations.

Ultimately, they suggested that “patient risk for complications and subsequent surgery should be explored, and multidisciplinary therapy including other medical disciplines is crucial to mitigate these risks.”


Related: Ciltacabtagene Autoleucel in Patients With MM and Prior SCT 

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