What is multiple myeloma?

Updated: Nov 01, 2018
  • Author: Andrew A Sama, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Multiple myeloma is a systemic disease that affects middle-aged people and is characterized by areas of local bone destruction. Multiple myeloma is the most common primary malignancy of bone and the spine. The underlying cell line is the malignant plasma cell, which produces abnormal quantities of immunoglobulins.

The presentation of patients with myeloma is similar to that of other spine tumor patients. Patients complain of pain that may be worse at night. The laboratory workup for these patients should include a complete blood count (CBC) with differential looking for anemia and thrombocytopenia, an elevation of the erythrocyte sedimentation rate (ESR), and a decrease in the serum albumin with increased total serum protein. The abnormal production of immunoglobulins can be detected on serum or urine electrophoresis and can be used to confirm the diagnosis.

Radiographically, skeletal survey is used to screen for lesions that can occur throughout the skeleton. Bone scans have a high false-negative rate and are not optimal studies for the evaluation of myeloma. Once a lesion is detected in the spine, CT, MRI, or both should be performed to assess the destruction of the vertebrae and the effect of this destruction on the surrounding neurologic and paraspinous tissues.

Multiple myelomas are generally sensitive to radiation therapy and chemotherapy. Surgery for stabilization is indicated in myelomas of the spine when destruction of the vertebral body exists to such an extent that collapse and possible kyphosis with canal compromise could result.

Prophylactic posterior stabilization can be carried out with segmental instrumentation in cases prior to fracture. Anterior strut grafting or cage reconstruction may be necessary once fracture and collapse have occurred. Adjuvant radiation therapy may be used postoperatively once healing of the surgical site has been obtained.

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