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Rates of postoperative complications remain high among patients with multiple myeloma (MM) undergoing spine surgery. These findings were published in the European Spine Journal.
Vertebral compression fractures (VCFs) are common among patients with MM, with up to 60% of patients presenting with VCFs at diagnosis and more than 60% developing VCFs during their disease course. Some patients undergo spinal surgery despite a paucity of data about surgical complications.
This retrospective cohort study reviewed data from Massachusetts General Hospital. A total of 270 patients who underwent spinal surgery for MM lesions between 2008 and 2021 were evaluated for postsurgical complications within 6 weeks of surgery and retreatment within 2.5 years.
The patients were mean age 65.0 (SD, 10.8) years, 58.1% were men, 91.1% had an Eastern Cooperative Oncology Group (ECOG) category of 0 to 2, and 66.9% had an age-adjusted Charlson Comorbidity Index (CCI) of 0 to 4.
Overall, 94 patients experienced a postoperative complication. The complication group was older (P =.045) and had a higher ECOG category (P =.003) than those who did not have a complication.
Among the 35% of patients who had at least 1 complication in the first 6 weeks, half the complications were serious. A fifth of patients underwent at least 1 reoperation within 2.5 years.
Predictors of postoperative complications included decompression surgery without fusion (odds ratio [OR], 6.53), preoperative steroid use (OR, 3.97), higher creatinine levels (OR, 2.18), higher Genant grading of present vertebral fracture (OR, 1.41), and lower calcium levels (OR, 0.58).
The predictors of reoperation were number of operated levels (sub-distribution hazard ratio [SHR], 1.57), ECOG performance score (SHR, 1.39), preoperative radiotherapy (SHR, 0.28), decompression with fusion surgery (SHR, 0.22), and corpectomy with fusion surgery (SHR, 0.16).
The study authors concluded, “Patient risk for complications and subsequent surgery should be explored, and multidisciplinary therapy including other medical disciplines is crucial to mitigate these risks.”
Reference
Zijlstra H, Pierik RJ, Crawford AM, et al. Analysis of complications and revisions after spine surgery in 270 multiple myeloma patients with spinal involvement. Eur Spine J. Published online September 14, 2023. doi:10.1007/s00586-023-07903-1
