Bone disease is observed in almost 80% of newly diagnosed symptomatic multiple myeloma patients, and spine is the bone site that is more frequently affected by myeloma-induced osteoporosis, osteolyses, or compression fractures. In almost 20% of the cases, spinal cord compression may occur; diagnosis and treatment must be carried out rapidly in order to avoid a permanent sensitive or motor defect. Although whole body skeletal X-ray is considered mandatory for multiple myeloma staging, magnetic resonance imaging is presently considered the most appropriate diagnostic technique for the evaluation of vertebral alterations, as it allows to detect not only the exact morphology of the lesions, but also the pattern of bone marrow infiltration by the disease. Multiple treatment modalities can be used to manage multiple myeloma-related vertebral lesions. Surgery or radiotherapy is mainly employed in case of spinal cord compression, impending fractures, or intractable pain. Percutaneous vertebroplasty or balloon kyphoplasty can reduce local pain in a significant fraction of treated patients, without interfering with subsequent therapeutic programs. Systemic antimyeloma therapy with conventional chemotherapy or, more appropriately, with combinations of conventional chemotherapy and compounds acting on both neoplastic plasma cells and bone marrow microenvironment must be soon initiated in order to reduce bone resorption and, possibly, promote bone formation. Bisphosphonates should also be used in combination with antimyeloma therapy as they reduce bone resorption and prolong patients survival. A multidisciplinary approach is thus needed in order to properly manage spinal involvement in multiple myeloma. 1. Introduction Multiple myeloma (MM) is a clonal B-cell disorder characterized by proliferation and accumulation of B-lymphocytes and plasma cells in the bone marrow and, more rarely, at extramedullary sites. Its annual incidence is 6/100000 in western countries, thus representing the second most common hematological malignancy after non-Hodgkin lymphomas [1]. Bone disease occurs in approximately 80% of patients with newly diagnosed MM, and in 70% of the cases bone pain is the first symptom to be reported at disease onset [2]. Pathological fractures, osteolyses, osteoporosis or, in general, skeletal-related events (SRE), that include also the need for radiotherapy or surgery to the bone, can severely impair patients quality of life and reduce survival [3]. Spine is the bone site that is most frequently affected by MM-related lesions [4]. Vertebral lesions can result
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