Abstract
Background Multiple myeloma is a haematological blood cancer in elderly patients, in which neoplastic
cell populations cause osteolytic destruction in the bone skeleton. More than 50%
of all patients sustain pathological fractures during the course of their disease.
Of all malignant lesions of the spine, multiple myeloma is the most frequent spinal
tumour and accounts for approximately 15% of all cases. 8 – 10% of the patients develop
neurological deficits. In addition to systemic antineoplastic therapy, surgical treatment
is often required in order to reconstruct and stabilise bone defects associated with
multiple myeloma, as well as to address tumour-related complications.
Methods A comprehensive literature search was performed in PubMed using the keywords “multiple
myeloma” and “surgery” or “fracture”. This served to evaluate the available primary
and secondary literature on the current status of the surgical therapy of multiple
myeloma. Systematic reviews, meta-analyses and clinical studies and international
recommendations for therapy were included – from 1975 until the spring of 2018.
Discussion Stabilising surgery is essential in order to retain and restore function and mobility
in bone sections affected by myeloma and for tumour-related osseous defects due to
pathological fracture or instability. Absolute and relative indications for surgical
treatment are distinguished and are based on the extent and localisation of bone lesions,
manifest fractures, accompanying side effects and complications such as neurological
deficits and bone pain that is intractable to conservative treatment. The range of
options in surgical treatment of myeloma-related bone damage within the upper and
lower extremities ranges from hybrid stabilisation procedures combining bone cement
and various implants, to conventional and modular tumour prostheses systems. In spinal
surgery, minimally invasive procedures such as kyphoplasty or vertebroplasty, as well
as selective decompressive operations, dorsal spinal fusion and vertebral replacement
are performed in cases of osseous defects and related fractures or instabilities.
The surgical treatment and time of operation is determined by the general individual
risk profile and prognosis of the patient with multiple myeloma. The surgical approach
should have the objective of a final and load stable solution for the patient, which
takes into account the frequent long-term course of the disease. Radiotherapy is often
recommended after surgery.
Conclusion In therapy of multiple myeloma, surgical treatment is often required in order to
reduce distress and retain the function and flexibility of myeloma affected bone sections
and the mobility and quality of life of the cancer patient. The range of surgical
strategies is complex and demanding.
Key words
multiple myeloma - pathologic fracture - operative treatment
