Overall Survival in Spine Myeloma Metastases: Difficulties in Predicting With Prognostic Scores

Study Design. Fifty-one patients with spinal multiple myeloma (MM) metastases were operated and followed between January 2004 and July 2014. Objective. The aim of this study was to consider the efficiency of surgical prognosis scores in the management of spinal metastases myelomas. Summary of Background Data. The spine is the most common site of bone metastases in MM. Surgery in spine metastases MM is a matter of debate and its impact on the increase of a patient's survival time is not clear. Several surgical survival scores have been developed to determine the best treatment in these patients. Methods. We studied 51 patients operated for spinal MM metastases between January 2004 and July 2014. We determined the Tokuhashi and Tomita survival scores and compared them with documented patient survivals. The two scores were also compared with the International Staging System (ISS). Results. Median survival (MS) was 108 months [standard deviation (SD) 62] for ISS I, 132.2 (SD 40) for ISS II, and 45.5 months (SD 16.3) for ISS III (P = 0.09). According to Tokuhashi survival score, 21 patients (41.2%) will survive < 6 months, 6 (11.8%) 6 to 12 months, and 24 (47%) > 12 months. According to Tomita et al., 50 patients (98%) will survive > 49.9 months and 1 patient (2%) < 15 months. Regardless of the ISS grade prognosis, Tokuhashi survival score, and to a lesser extent Tomita score, underestimated the actual survival very significantly [P< 0.0001, Log Rank (Mantel-Cox)]. Conclusion. We suggest that spine surgical prognosis scores are not accurate and are not able to predict the survival of patients with spine myeloma metastases. Spine surgeons have to be guided not by the initial ISS stage but rather by spinal instability and neurological status.