Treatment Options for Multiple Myeloma: Surgical Interventions and Comprehensive Care Strategies

Multiple myeloma is a malignant disorder of the blood that originates in plasma cells within the bone marrow. As a systemic disease, its primary treatments involve chemotherapy, targeted therapy, and, in eligible patients, autologous hematopoietic stem cell transplantation. While surgery does not play a central role in treating the cancer itself, it can be a critical component in managing complications arising from the disease, particularly those related to bone destruction.

When Is Surgery Considered in Multiple Myeloma?

Surgical intervention is not used to cure multiple myeloma but may be necessary to address severe skeletal complications caused by the disease. As myeloma cells infiltrate the bone, they lead to osteolytic lesions, weakening the skeletal structure and increasing the risk of fractures and spinal instability.

Common Indications for Surgical Treatment

Persistent pain unresponsive to medical management is one of the key reasons a patient might be evaluated for surgery. When tumors compress nerves or the spinal cord, it can result in debilitating discomfort that impacts quality of life.

Neurological compromise, such as weakness, numbness, or loss of bowel and bladder control due to spinal cord compression, requires urgent surgical evaluation. Immediate decompression—often through laminectomy or tumor debulking—is essential to prevent permanent nerve damage.

Spinal instability resulting from vertebral collapse or tumor involvement may necessitate spinal fusion or instrumentation to restore structural integrity and prevent further injury.

Pathological fractures, especially in weight-bearing bones like the femur or vertebrae, often require stabilization with rods, screws, or other orthopedic hardware to allow mobility and reduce pain.

Minimally Invasive Procedures: Kyphoplasty and Vertebroplasty

For patients suffering from vertebral compression fractures due to myeloma, percutaneous kyphoplasty offers a less invasive option. During this procedure, a small balloon is inserted into the collapsed vertebra and inflated to restore height, followed by the injection of bone cement to stabilize the fracture.

This technique has been shown to provide rapid pain relief, improve spinal alignment, and enhance overall function. Compared to open surgery, kyphoplasty typically involves shorter hospital stays and faster recovery times, making it ideal for patients whose overall health may limit more extensive interventions.

Timing and Patient Selection Are Crucial

Deciding when to proceed with surgery requires careful assessment of the patient's systemic condition. Factors such as disease burden, response to prior therapies, bone marrow reserve, and comorbidities must all be weighed. Surgery is generally recommended only when the benefits—such as pain control, neurological preservation, or improved mobility—outweigh the risks associated with anesthesia and postoperative recovery.

A Multidisciplinary Approach to Optimal Outcomes

Successful management of multiple myeloma and its complications relies on collaboration among hematologists, oncologists, radiologists, neurosurgeons, and orthopedic surgeons. Integrating surgical options into a comprehensive treatment plan ensures that patients receive timely and appropriate care tailored to their individual needs.

In conclusion, while surgery does not target the underlying malignancy in multiple myeloma, it plays a vital supportive role in enhancing quality of life, preserving function, and preventing long-term disability. With advances in both medical and surgical techniques, patients now have more options than ever to manage the skeletal consequences of this complex disease.