P-127: The role of spinal bracing in the management of Multiple Myeloma Spinal and Sternum disease

Introduction: Spinal involvement is the most common site of MM bone disease and is associated with inferior survival. Traditionally the management of MM spinal disease was with either minor or major surgical intervention for spinal stability. The role of spinal bracing(SB) for spinal instability and support is unclear. This study aimed to explore the impact of SB on the maintenance of spinal stability prevention of new fractures and deformity.

Methods: We retrospectively evaluated the electronic records of multiple myeloma patients who were followed up in clinic between 2018-2023 and had SB.

Results: Of the 905 MM patients, we identified 422 patients who had SB, 372(88%) at diagnosis and 50(12%) at relapse. 211(50%) patients had CTLSO brace, 208 (49%) TLSO and 3(1%) hard cervical collar. The indication for SB was spinal involvement 420(99%), spinal fractures 347(82%), spinal lesions 73(17%) and 4(1%) fractures and lesions. 135(32%) had sternum involvement; 94 (21%) had sternum lesions, 46(10%) sternum fracture and 5(1%) combination of both. The duration of SB was 3 months for 386(91%) patients. 91% of the patients received bisphosphonates. Systemic MM treatment included proteasome inhibitors and Immunomodulatory agents. At the time of SB 422(100%) experienced pain 78(18%) neurological signs or symptoms, 78(18%) had spinal plasmacytomas, 65(15%) spinal cord compression, 67(16%) received radiotherapy and 11(3%) had surgical interventions. Only 3 patients requiring SB at relapse, had previous surgery at the same spinal level. Most patients (96%) showed radiological signs of new bone formation and spinal stability on imaging and for 9(9%) imaging showed progressive deformity. The incidence of worsening of pre-existing fracture was 17.5% and occurred within the first 4.3(1-4.3) months. The incidence of subsequent fractures below SB was 16%. 28 patients showed radiological signs of worsening of preexisting fractures and 7 experienced new fractures below the level of SB: 32 at diagnosis and 3 at subsequent relapses. 18 had CTLCO and 17 TLSO brace and 29 required SB for 3 months. 33 had spinal and 10 sternum involvement. 9 also received radiotherapy (3 for spinal plasmacytomas, 4 for neurological symptoms, 2 for SCC) . In this group of patients 1 showed progressive deformity and 8 showed signs of new bone formation.

Conclusions: In this largest real world study patients with spinal and sternum disease were managed with SB. Early SB was a safe non-invasive method which played a major role in the prevention of spinal fractures and preservation of spinal alignment. A low risk of worsening of pre-existing fracture was observed mainly within the first 4 months. This is stressing the need for early intervention and repeating imaging if new or worsening pain. None of the patients from this cohort with spinal instability required additional surgical interventions and the incidence of longer-term spinal deformity was low.