Introduction: To assess the need for surgical intervention and outcomes in patients with spinal metastases secondary to multiple myeloma (MM).
Methods: Our radiology quality assurance database was retrospectively queried to identify patients with spinal metastases due to MM, (01/2017-12/2021). Demographics, setting of initial imaging (inpatient/outpatient/ED), histology, MM international staging system (ISS), treatment modality, spinal stability, number of affected levels, presence of compression fractures, surgical intervention (open surgery/kyphoplasty and surgical details, time to treatment (TTT), baseline ASIA score, and 1-year ambulatory status and mortality were recorded. The surgical group included patients who underwent open spine surgery and/or kyphoplasty, while the non-surgical group included all patients who did not require either. Multivariable logistic regression models, adjusted for confounding factors, were used to identify independent predictors of 1-year mortality and ambulatory status. Analysis was performed with R software 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria).
Results: In total, 99 patients with MM spine metastases were identified with mean age 64.4 (SD 12.2), 64 (61.6%) being males. The surgical group included 21 patients (non-surgical 78). At diagnosis, 23 (23.2%) patients had spinal instability, 50 (50.5%) had a compression fractures, 64 (64.6%) had >5 involved levels, 44 (44.4%) had neural element compression and 18 (18.2%) required instrumented fusion. The median time to treatment (11 days; IQR 28.5) was significantly shorter in the surgical group (3; IQR 11) compared to the non-surgical group (13.5; IQR 31, P< 0.001). In bivariate analyses, age, TTT, baseline ASIA, spinal instability, compression fractures, neural compression, and need for instrumentation were identified as potential confounders. One-year mortality was 16% in the surgical group and 19.6% in the non-surgical group (P=0.9). Among survivors, 100% of the surgical group and 98% of the non-surgical group were ambulatory (P=1). In multivariable analysis, shorter TTT was an independent predictor of 1-year mortality (OR=-0.09, CI: 0.82-0.97, P=0.039). No significant predictors for 1-year ambulatory status were identified.
Conclusion : Time to treatment was an independent predictor of 1-year survival, though its clinical significance remains uncertain. Future studies with larger sample sizes are needed to identify additional independent predictors.
.jpg)
