A study of patients with multiple myeloma (MM) who had undergone surgical procedures for lesions in extremities or the pelvic region suggested that surgeries often enabled pain relief and improved function, and outcomes were generally better for upper extremity or diaphyseal lesions.

According to the study investigators, there is limited research on skeletal manifestations of MM necessitating surgery. They had a goal of evaluating improvements in pain and function in patients after a variety of surgical interventions for MM.

This retrospective analysis included patients with MM who had been treated at Marmara University in Istanbul, Turkey. Numerous variables had been recorded prior to surgery and a visual analogue scale (VAS) was used for measuring pain intensity before and after surgery. Functional status before and after surgery was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.


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The study included 49 patients, 26 of whom were newly diagnosed, and the mean age was 60.8 years. With a mean study follow-up of 47.7 months, 6 patients had experienced multiple surgeries, for a total of 57 procedures across the population. A total of 27 patients were reported alive at the time of the analysis.

Following surgery, improvements were seen across the patient population in terms of pain, mobility, and motion of extremities. Patients had a mean VAS score of 8.75 before surgery, which was lower after surgery at the time of discharge (mean of 3.21), and at last follow-up (mean of 1.2). The difference between preoperative VAS scores and those obtained during discharge was significant (P =.0001). However, VAS scores at discharge and final follow-up were not significantly different (P =.086).

Before surgery, the mean MSTS functional score was 9.1%, and at last follow-up the mean score had risen to 76% (P =.0001). The mean MSTS score was highest following surgeries in the upper extremities (85.8%), in comparison with those in the lower extremities/pelvic region (70.8%; P =.04). The mean MSTS score was also greater with management of isolated diaphyseal lesions (87.9%), in comparison with metaphyseal/articular lesions (70.1%; P =.032).

There were 11 complications overall, 19.2% of which required reoperation. Reoperation occurred less often in upper extremities and in isolated diaphyseal areas, but these differences were not statistically insignificant.

“The surgical management of symptomatic, extensive myeloma lesions, mostly associated with a pathological fracture, provided a significant clinical improvement throughout this series; all the patients improved postoperatively with regard to pain, extremity motion, and mobility,” the study investigators wrote in their report.

Reference

Topkar OM, Erol B. Clinical outcomes and complications of surgical interventions for multiple myeloma lesions in the extremities and pelvis: a retrospective clinical study. Acta Orthop Traumatol Turc. 2021;55(2):159-165. doi:10.5152/j.aott.2021.20130