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Metastatic glioblastoma to the vertebral spine is rarely encountered. The decision to intervene surgically must consider the poor prognosis in these patients. Here we report the case of a 46-year-old woman who presented with sudden weakness of the lower extremities 10 months after diagnosis of a left parietal glioblastoma. Imaging revealed osseous metastases to the thoracic and lumbosacral vertebral bodies. She initially underwent vertebroplasty with symptomatic improvement, but the progression of disease precluded further surgical interventions, and the patient was referred for chemotherapy and radiotherapy. The case illustrates that the choice of treatment modality varies throughout the time course of the disease—patients with spinal instability or few solitary metastases may benefit from intervention, but as the disease burden increases, palliative radiotherapy and chemotherapy may offer greater benefit. [ABSTRACT FROM AUTHOR]

Background Context: Nearly 70% of patients with multiple myeloma (MM) experience vertebral fracture. As a consequence, these patients suffer significantly poorer quality of life. However, no studies have characterized the natural progression of these fractures.Purpose: The purpose of this study was to characterize the progression of MM-associated vertebral fractures.Study Design/setting: A consecutive retrospective chart review at a single tertiary-care center was carried out.Patient Sample: Patients with MM and pathologic vertebral fracture with at least one follow-up between January 2007 and December 2013 were included. Radiographic measurements were recorded until last follow-up (LFU) or until surgical intervention or patient death. Patients with a history of vertebral fracture not associated with MM were excluded.Outcome Measures: The primary outcome measure was change in height of the fractured vertebrae. Fractures were characterized by Genant grade and morphology.Methods: At baseline and each follow-up, anterior, middle, and posterior vertebral body heights were measured from midline sagittal T1-weighted magnetic resonance imaging. Student t tests and Fisher exact tests were performed to identify variables associated with fracture progression.Results: Among 33 patients, 67 fractures were followed. Sixty-four percent of patients were female, with a mean age of 66. Baseline mean anterior, middle, and posterior vertebral body height losses were 30%, 36%, and 15%, respectively. Forty-three percent of fractures were Genant grade 3, and 57% were biconcave. Mean time to LFU was 40 months. At LFU, mean anterior, middle, and posterior vertebral body height losses increased to 47% (p<.01), 49% (p<.01), and 28% (p<.01), respectively. More fractures became Genant grade 3 (75%, p<.01) and wedge (54%, p=.03). On average, patients lost 0.83% in vertebral body height per month, with initial Genant grade 1 fractures progressing most rapidly (1.69%/month, p<.01). Patients treated with bisphosphonates suffered less additional height loss compared with untreated patients (14% vs. 24%, p=.07).Conclusions: We observed significant fracture progression despite high utilization of bisphosphonates. Patients lost nearly 1% of additional vertebral body height per month, with the least severe presenting fractures progressing most rapidly, highlighting the necessity for early referral to spine specialists and evidence-based guidelines for surveillance and treatment in the myeloma population. [ABSTRACT FROM AUTHOR]

Background Context: Patients with multiple myeloma (MM) incur significant degradation in quality of life because of progressive osteolytic vertebral fractures. No studies have investigated predictors of fracture progression, and limited data are available for predicting the development of future fractures.Purpose: The purpose of this study was to identify independent predictors of vertebral fracture progression and the development of future vertebral fracture.Study Design/setting: This is a consecutive retrospective chart review at a single tertiary-care center.Patient Sample: Patients with MM and pathologic vertebral fracture with radiographic follow-up between January 2007 and December 2013 were included. Radiographic measurements were recorded at presentation with fracture and first follow-up (FFU) after at least three months. Patients with a history of vertebral fracture not associated with MM were excluded.Outcome Measures: The primary outcome measure was the rate of vertebral body height loss. The development of future vertebral fracture was secondary.Methods: Anterior, middle, and posterior vertebral body heights were measured from midline sagittal T1-weighted magnetic resonance imaging (MRI). Future fracture-free survival was calculated using Kaplan-Meier analysis. Multivariable regression was used to identify independent predictors of the rate of vertebral height loss. Multivariable Cox proportional hazards modeling was used to identify predictors of developing future vertebral fracture.Results: Thirty-three patients with 67 fractures were followed for a median of 10.8 months to FFU. Sixty-four percent of the patients were female and the median age was 66. The median additional vertebral height loss between presentation and FFU was 15%, whereas the median rate of vertebral height loss was 1.01%/month. More rapid vertebral height loss was predicted by dyslipidemia (β=0.36, p=.05), previous non-vertebral pathologic fracture related to MM (β=0.51, p=.01), and Durie-Salmon Stage III (β=0.66, p=.06). The median time to future fracture was 25.1 months; the 5-year future fracture-free survival rate was 34%. Osteopenia/osteoporosis (hazard ratio [HR]: 9.28, p<.01), serum light chains (HR: 1.37, p=.06), and serum calcium (HR: 1.62, p=.05) predicted the development of future vertebral fracture.Conclusions: We observed significant fracture progression over a short follow-up period. Several comorbidities and laboratory measures predicted more rapid vertebral height loss and the development of future fracture. Identifying risk factors for increased fracture burden may allow spine specialists to pursue earlier and appropriate intervention to optimize function and minimize morbidity. [ABSTRACT FROM AUTHOR]