Surgery for Multiple Myeloma

Multiple myeloma surgery may be required to help control pain or retain function or mobility. These may include physical therapy, splinting of bones to prevent or treat fractures, or surgical procedures (minor or major) to repair fractures.

Simply stated, patients with myeloma experience bone destruction because rapidly growing myeloma cells push aside normal bone-forming cells and produce substances that activate bone-resorbing cells. Both of these cause areas of bone weakness that can increase the risk of broken bones.

The skeletal site most often affected by myeloma is the spine. Fractures of the bones of the spine (vertebrae) are associated with bone pain in more than half of patients when they are first diagnosed. (Body JJ. Cancer. 97(3 suppl):859-865.) New vertebral fractures occur in approximately 15 to 30 percent of patients with myeloma every year. The vertebrae become so weakened that they collapse upon themselves, resulting in a compression fracture. These fractures are very painful and can lead to a stooped posture, loss of height, immobility, and further fractures. Consequently, they have a significant impact on quality of life. Compression fractures, by reducing space in the chest and abdominal cavities, can also reduce lung capacity and cause loss of appetite.

Treatment for spinal fractures includes the use of painkillers to control pain and increasing physical activity, preferably under professional supervision in the form of physical therapy. Water exercises are also very useful in the management of spinal fractures.

Symptoms of spinal fractures are sometimes treated with bed rest and braces. However, these methods may lead to further deterioration in a patient’s condition and are now being used less frequently. For example, bed rest and inactivity can lead to further weakening of the bone and decreased incorporation of new calcium into bone. Braces, although they provide significant comfort, may weaken muscles, which can also lead to further weakening of bone.

Although treatments for myeloma help control the disease, they do not correct any structural damage that may have already occurred with a fracture or stop continued worsening of the condition. Two surgical procedures—vertebroplasty and kyphoplasty—are used to treat spinal fractures due to osteoporosis (generalized bone weakening), bone metastases, or myeloma. By stabilizing the bone, these procedures help address the structural damage seen with spinal fractures, help relieve pain, and improve function and quality of life.