Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9023
Peer-review started: March 12, 2021
First decision: July 16, 2021
Revised: July 26, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: October 26, 2021
Multiple myeloma is an incurable malignant plasma cell disorder that represents the most common primary malignant bone tumor. It commonly involves bone metastasis in multiple vertebral bodies, and the Spinal Instability Neoplastic Score scoring system may not be fully applicable to multiple myeloma (MM) patients.
To evaluate the spinal stability of patients with MM spinal involvement to guide their clinical treatment.
By using the Delphi method, we collected and extracted information through a series of questionnaires and improved it via feedback. We also preliminarily established a spinal stability scoring system for multiple myeloma.
Fifteen clinicians completed a second round of questionnaires and compared their answers with those of the first round of questionnaires to identify significant comments or changes that required group discussions. As a result, no further feedback was used to improve the scoring system. After integrating the information from the expert consultation questionnaire, we established the initial scoring system for MM spine stability and used the scoring system to assess a series of representative clinical cases. The MM spinal stability scoring system was created by calculating the scores of the six separate components: location, pain, number of segments, physiological curvature, comorbidities, and neurological function. The minimum value was “0”, and the maximum value was “24”. A score of “0–10” indicated “spine stability”, a score of “11–17” indicated “potential instability”, and a score of “18–24” indicated “spine instability”. Patients with a score of “11–24” need an intervention such as surgery.
The initial establishment of the MM spine stability scoring system provides a vital theoretical basis for the evaluation of spine stability in individuals with MM.
Core Tip: Multiple myeloma (MM) is an incurable malignant plasma cell disorder that represents the most common primary malignant bone tumor. According to the 2010 Spine Oncology Study Group, spinal instability is defined as the loss of spinal integrity due to tumor growth, which is associated with motor-related pain and symptoms, progressive deformities, and/or impairments in neurological function under physiological loads. Many studies have validated this scoring system and applied it in clinical practice for diseases including primary spinal tumors, metastatic spinal tumors, and MM. However, MM is different from other primary and metastatic malignant tumors of the spine. Osteolytic destruction is the most common type of bone destruction in most MM patients; it commonly involves bone metastasis in multiple vertebral bodies, and is often accompanied by peripheral soft tissue masses and nerve compression symptoms. To some extent, Spinal Instability Neoplastic Score is not applicable to MM patients. Based on the disease characteristics of multiple myeloma, a simple and practical new method for evaluating spinal stability in individuals with multiple myeloma is proposed, and can be used for the clinical evaluation and intervention of multiple myeloma patients.