Neurological Outcomes and the Need for Retreatments Among Multiple Myeloma Patients With High-Grade Spinal Cord Compression: Radiotherapy vs Surgery

Global Spine Journal, 2025 · DOI: 10.1177/21925682231188816 · Published: January 1, 2023

Simple Explanation

This study investigates the best way to treat spinal cord compression in multiple myeloma patients. Spinal cord compression can cause serious nerve damage, so quick and effective treatment is important. The researchers compared two common treatments: radiotherapy and surgery. They looked at how well patients recovered their nerve function and how often they needed additional treatments. The study found that surgery may lead to better nerve recovery and less pain compared to radiotherapy, without increasing the need for further treatments. This suggests surgery could be a beneficial option for these patients.

Study Duration

January 2010 and June 2021

Participants

247 patients with Multiple Myeloma and high-grade ESCC

Evidence Level

Retrospective cohort study

Key Findings

1
Surgical treatment was associated with significantly lower odds for neurological deterioration compared to radiotherapy (OR = .15; 95% CI .05 - .44; P < .01).
2
Patients treated with surgery experienced significantly less pain compared to those treated with radiotherapy (OR = .29; 95% CI .11 - .74; P = .010).
3
There was no statistically significant difference in the risk of retreatments between surgery and radiotherapy (OR = .64; 95% CI .28 - 1.47; P = .29).

Research Summary

This retrospective cohort study compared neurological outcomes and retreatment rates in multiple myeloma patients with high-grade ESCC treated with radiotherapy or surgery. The study found that surgically treated patients showed better neurologic outcomes and less pain compared to patients treated with radiotherapy, after adjusting for baseline differences. There were no significant differences in retreatment rates or mortality between the two treatment groups.

Practical Implications

Treatment Considerations

Surgery should be considered as a viable treatment option for patients with high-grade ESCC from MM, especially when neurologic deterioration and pain are primary concerns.

Multidisciplinary Approach

Management of ESCC in MM patients requires a multidisciplinary approach, including consultation with a spine surgeon.

Future Research

Future research should explore the association between the duration of MM disease and treatment outcomes to refine treatment strategies.

Study Limitations

1
Retrospective data collection may impact result accuracy due to reliance on clinician notes and perceptions.
2
Selection bias exists in patients chosen for surgery due to unmeasured clinician judgment variables.
3
Relatively small patient number included.

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