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Analysis of complications and revisions after spine surgery in 270 multiple myeloma patients with spinal involvement
H Zijlstra1,2, R J Pierik3, A M Crawford3
1Department of Orthopedic Surgery/Orthopedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. h.zijlstra-2@umcutrecht.nl.
Background Context:
Patients with multiple myeloma (MM) are at increased risk of infections and suffer from poor bone quality due to their disseminated malignant bone disease. Therefore, postoperative complications may occur following surgical treatment of MM lesions.
Purpose:
In this study, we aimed to determine the incidence of postoperative complications and retreatments after spinal surgery in MM patients. Additionally, we sought to identify risk factors associated with complications and retreatments.
Study Design:
Retrospective cohort study.
Patient Sample:
In total, 270 patients with MM who received surgical treatment for spinal involvement between 2008 and 2021 were included.
Outcome Measures:
The incidence of perioperative complications within 6 weeks and reoperations within 2.5 years and individual odds ratios for factors associated with these complications and reoperations.
Methods:
Data were collected through manual chart review. Hosmer and Lemeshow's purposeful regression method was used to identify risk factors for complications and reoperations.
Results:
The median age of our cohort was 65 years (SD = 10.8), and 58% were male (n = 57). Intraoperative complications were present in 24 patients (8.9%). The overall 6-week complication rate after surgery was 35% (n = 95). The following variables were independently associated with 6-week complications: higher Genant grading of a present vertebral fracture (OR 1.41; 95% CI 1.04-1.95; p = .031), receiving intramuscular or intravenous steroids within a 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 creatinine levels (OR 2.18; 95% CI 1.19-5.60; p = .014), and lower calcium levels (OR 0.58; 95% CI 0.37-0.88; p = .013). A secondary surgery was indicated for 53 patients (20%), of which 13 (4.8%) took place within two weeks after the initial surgery. We additionally discovered factors associated with retreatments, which are elucidated within the manuscript.
Conclusion:
The goal of surgical treatment for MM bone disease is to enhance patient quality of life and reduce symptom burden. However, postoperative complication rates remain relatively high after spine surgery in patients with MM, likely attributable to both inherent characteristics of the disease and patient comorbidities. The risk for complications and secondary surgeries should be explored and a multidisciplinary approach is crucial.
Insights
Spinal surgery in multiple myeloma (MM) patients has a 35% complication rate within 6 weeks. Risk factors include vertebral fracture severity, steroid use, and kidney/calcium levels, highlighting the need for careful management.
Area of Science:
- Orthopedic Surgery
- Oncology
- Neurosurgery
Background:
- Patients with multiple myeloma (MM) face increased infection risks and poor bone quality.
- Surgical treatment of MM bone lesions can lead to significant postoperative complications.
Purpose of the Study:
- To determine the incidence of postoperative complications and retreatments after spinal surgery in MM patients.
- To identify risk factors associated with these complications and subsequent surgeries.
Main Methods:
- Retrospective cohort study of 270 MM patients undergoing spinal surgery (2008-2021).
- Data collected via manual chart review.
- Hosmer and Lemeshow's purposeful regression used to identify risk factors.
Main Results:
- A 35% complication rate within 6 weeks post-surgery was observed.
- Independent risk factors for complications included vertebral fracture severity, prior steroid use, decompression without fusion, and abnormal creatinine/calcium levels.
- 20% of patients required a secondary surgery within 2.5 years.
Conclusions:
- Postoperative complication rates after spine surgery in MM patients remain high.
- Disease characteristics and comorbidities contribute to these risks.
- Further investigation into complication risks and a multidisciplinary approach are crucial for patient care.
