Evolving Trends in Surgical Management of Spinal Multiple Myeloma: A Decade-Long Analysis of Vertebral Augmentation and Spinal Stabilization (2009-2020)

Introduction: Management of multiple myeloma (MM) of the spine continues to evolve with a multimodal approach involving chemotherapy, bisphosphonates, radiation, and surgical intervention. This study explores trends in surgical treatment for MM, including hospital costs, odds of complications, and the impact of patient comorbidities using the National Inpatient Sample (NIS) database from 2009 to 2020.

Methods: The NIS was queried for patients with MM and plasmacytoma of the spine who underwent surgical intervention between 2009 and 2020. Rates of spinal decompression, spinal stabilization with or without decompression, and vertebral augmentation were analyzed. A multivariate analysis was conducted to assess the effect of various patient characteristics on outcomes, stratified by surgical procedure.

Results: Vertebral augmentation remained the most common procedure (12,500, 60.3%), though its use gradually declined over time. Spinal stabilization showed a significant increase (6,200, 30%), while decompression alone remained stable (1,000, 7.7%). The population-adjusted rate of surgical management for MM slightly increased during the study period, primarily driven by spinal stabilization procedures (P < 0.001), while vertebral augmentation showed a modest decrease (P=0.01).
Vertebral augmentation continued to be associated with shorter inpatient hospital stays (mean LOS: 3.5 days) and lower total costs (average cost: $18,500). However, its complication rate increased over time (P < 0.001). Spinal stabilization and decompression showed stable complication rates (P>0.05) but were linked to longer hospital stays (mean LOS: 6.5 days) and higher costs (average cost: $28,000).
Complication rates were significantly higher in male patients (P < 0.001) and correlated positively with the number of patient comorbidities (P < 0.001).

Conclusion : The surgical management of spinal MM from 2009 to 2020 shows increasing utilization of spinal stabilization while vertebral augmentation has decreased. This reflects advancements in surgical techniques and technology, allowing for safer and more effective interventions. Patient comorbidities remain a critical factor in deciding on surgical interventions.