BackCare

Myeloma causing osteoporosis and the vertebrae becoming wedgeshaped

2008 Author: Alan Gardner FRCS

I am currently aged 64 and was diagnosed with Myeloma in December 2006

Question

I would be grateful to hear from you if you have any views or suggestions on my back condition, and whether any other readers have a similar problem.

I am currently aged 64 and was diagnosed with Myeloma in December 2006. I’d had rib and chest pains for about six months, but x-rays and other tests revealed nothing unusual. It became increasingly difficult to lie down and sleep at night, and then one night I was in such pain in my chest and back that my daughter dialled 999 and, after a morphine injection, I was taken to hospital where I stayed for nearly five weeks. During this time I became quite ill spending most of my time on oxygen, half propped up in bed. When I came out I found I had lost 6" in height, my sternum had shortened and my back was severely curved (kyphosis).

This was explained to me as the Myeloma causing osteoporosis and the vertebrae becoming wedgeshaped. Some six months later (last summer) I saw an orthopaedic surgeon with a view to having balloon kyphoplasty. He was able to put bone cement into one of the lower thoracic vertebrae as a preventative measure, but was unable to do anything about the curvature – partly because he said too much time had elapsed since the ‘fractures’ and partly because the shortened sternum would not allow the back to be straightened. There is some confusion as to whether the sternum was broken and has slipped, or if it has folded on itself, but neither my consultant for the Myeloma (who is a haematologist), nor the orthopaedic consultant, had apparently ever seen anything like it, and didn’t think that anything could be done.

As a very quick history, I have always been very active, participating in competitive sport until the age of 50 when I developed a slipped disc in the lower lumber vertebrae, but after recovery from this*, I continued with keep fit activities such as gym work, power walking, cycling etc right up until about two weeks before I was taken into hospital. You can therefore imagine my dismay and disbelief when I came out of hospital with a completely changed skeleton. It has taken me 18 months to get back to anything like a normal life, but I am still very restricted as the poor posture causes lots of aches when walking or standing, or even sitting at a desk for any length of time (I have had to give up work). Also, because of the poor posture, I now have only 70% lung capacity. I had 18 weeks chemotherapy treatment until April last year, and am still on OxyContin and paracetamol pain killers, which I fear I have now become dependant on, as I feel strangely unwell when they begin to wear off. I am however gradually decreasing them to try to alleviate this problem, as most of my pain now, I think, is probably muscular. (Your views on taking these drugs long-term would also be appreciated.)

Unfortunately I am still living under the anxiety that sooner or later the Myeloma will return and I am not sure what further problems this will bring. I have blood tests and see my consultant every three months.

1. Whether you think anything could have been done while I was in hospital to help to prevent this collapse which, although too late for me, might help others in a similar position; and
2. Whether there is anything you can suggest that I can still do to have a better quality of life. I am trying to get some level of fitness back, but the poor posture and fear of breaking bones is very limiting. I have never been a believer in braces and the like as, having been a fitness fanatic, have always thought one should build up the muscles instead, but if you think there is a brace or something similar that might help me to have a more normal life now, I would be very pleased to hear from you, or any readers with a similar problem.

Mrs S – West Sussex

Answer

A Myeloma is a disease of the bone marrow, not very common but wellrecognised. Apart from making you feel rotten, it erodes bone causing pain and structural weakness which often results in vertebral collapse depending on the number of levels involved. Sometimes it is only one or two but Mrs S was evidently unlucky with many levels affected and a correspondingly greater degree of vertebral wedging, shortening and angulation. What to do about it? Clearly the first priority is to control the myeloma which is malignant and lifethreatening. This is usually achieved with chemotherapy as in this case. Happily this has been successful and it is now nearly two years since diagnosis.

Mrs S describes her residual forward-bent spine which makes life difficult because of the strain of trying to maintain a reasonably upright posture and the aching and pain that results. The fact that she was very fit beforehand and is determined to stay as active as possible now and in the future indicates that she will make the best of a difficult situation, as unfortunately there is not much else that we can offer apart from understanding and encouragement.

Balloon arthroplasty is a useful technique to regain vertebral height in severe osteoporosis provided there is some flexibility in the spine, but when there is ingrowth of tumour tissue as in myeloma, this has to be surgically removed before inflating the balloon and inserting bone cement. This involves major surgery and is really only practical at two or three levels at the most and only then if there is enough strength left in the bone to take the strain. Not really an option for Mrs S.

Could anything have been done to prevent her curvature? The only possibility would have been a rigid and extensive but removable spinal jacket worn more or less continuously for about six months from before her chemotherapy. This would have been uncomfortable and of limited and unpredictable effectiveness depending on the amount of bone left in the spine, then possibly supplemented by stabilising surgery – probably not worth the considerable effort and endurance. However, now that individuals are surviving these severe diseases with the help of advanced chemotherapy, we have to think of new ways of tackling these difficult problems.

As Mrs S says, any experience from readers or medics would be of interest. I do not think that bracing at this stage has anything to offer, it would be uncomfortable and probably ineffective. It is best to rely on one’s own muscles as Mrs S suggests, along with simple pain-killers such as paracetamol. OxyContin is more complex and your Doctor’s instructions should be followed carefully. We all wish you well and do keep in touch.

Alan Gardner
Consultant Spinal Orthopaedic Surgeon (Rtd)