{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:36:35Z","timestamp":1769729795809,"version":"3.49.0"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"23","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,12,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Patients with multiple myeloma (MM) are commonly managed by multidisciplinary oncology teams in concordance with the neurological, oncological, mechanical, and systematic decision framework. Surgery is indicated for mechanical instability and\/or neurological deficits. In neurologically intact and mechanically stable patients, chemo- and radiotherapy alone are often the mainstay treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 66-year-old male patient presented with a kyphotic chin-on-chest deformity due to undiagnosed spinal MM. He experienced progressive neck pain and difficulty with activities of daily living (ADLs). Imaging revealed systematic bony element destruction and burst deformities at T1\u20132 with cervicothoracic central canal stenosis. Due to his disease burden and neurological preservation, spinal alignment was initially achieved via halo traction and immobilization, allowing him to begin systemic therapy almost immediately after diagnosis and improving vertebral bone density and construct integrity prior to surgery. He underwent C2\u2013T10 decompression and instrumented fusion with cement augmentation. At 12 months postoperatively, the patient reported improvement in symptomology and ADLs without radiographic evidence of hardware failure or spinal instability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Spinal MM with instability can be successfully managed with gradual deformity realignment and external orthosis before surgery in a neurologically intact patient with a significant disease burden.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2441\">https:\/\/thejns.org\/doi\/10.3171\/CASE2441<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2441","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T01:51:45Z","timestamp":1733104305000},"source":"Crossref","is-referenced-by-count":0,"title":["Management of atraumatic chin-on-chest deformity in newly diagnosed multiple myeloma: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Helen","family":"Karimi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island"},{"name":"Tufts University School of Medicine, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul A.","family":"Sastry","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hael","family":"Abdulrazeq","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jamaica Hospital Medical Center, Queens, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianyi","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Am Fam Phys","first-page":"373","article-title":"Multiple myeloma: diagnosis and treatment","volume":"95","author":"Michels","year":"2017","unstructured":"Michels TCPetersen KE. 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Cureus. 2021;13(10):e19131."},{"issue":"6","key":"bib4","series-title":"Spine","first-page":"400","article-title":"Overall survival in spine myeloma metastases: difficulties in predicting with prognostic scores","volume":"42","author":"Amelot","year":"2017","unstructured":"Amelot ACristini JSalaud C, et al. Overall survival in spine myeloma metastases: difficulties in predicting with prognostic scores. Spine. 2017;42(6):400-406."},{"issue":"6","key":"bib5","series-title":"Neurosurgery","first-page":"757","article-title":"State of the art treatment of spinal metastatic disease","volume":"82","author":"Barzilai","year":"2018","unstructured":"Barzilai OFisher CGBilsky MH. State of the art treatment of spinal metastatic disease. Neurosurgery. 2018;82(6):757-769."},{"issue":"6","key":"bib6","series-title":"Oncologist","first-page":"744","article-title":"The NOMS framework: approach to the treatment of spinal metastatic tumors","volume":"18","author":"Laufer","year":"2013","unstructured":"Laufer IRubin DGLis E, et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013;18(6):744-751."},{"issue":"3","key":"bib7","series-title":"J Neurosurg Spine","first-page":"301","article-title":"Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column","volume":"22","author":"Zadnik","year":"2015","unstructured":"Zadnik PLGoodwin CRKarami KJ, et al. Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column. J Neurosurg Spine. 2015;22(3):301-309."},{"issue":"3","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"320","article-title":"Multiple myeloma: surgery of the spine: retrospective analysis of 27 patients","volume":"27","author":"D\u00fcrr","year":"2002","unstructured":"D\u00fcrr HRWegener BKr\u00f6del AM\u00fcller PEJansson VRefior HJ. Multiple myeloma: surgery of the spine: retrospective analysis of 27 patients. Spine (Phila Pa 1976). 2002;27(3):320-326."},{"key":"bib9","series-title":"Surg Oncol","first-page":"101927","article-title":"Spinal lesions in multiple myeloma: primary bone tumors with distinct prognostic factors","volume":"48","author":"Ly","year":"2023","unstructured":"Ly RTerrier LMCognacq G, et al. Spinal lesions in multiple myeloma: primary bone tumors with distinct prognostic factors. Surg Oncol. 2023;48:101927."},{"key":"bib10","series-title":"Scientifica","first-page":"104546","article-title":"Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement","volume":"2013","author":"Tosi","year":"2013","unstructured":"Tosi P. Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement. Scientifica. 2013;2013:104546."},{"issue":"0","key":"bib11","series-title":"Clin J Oncol Nurs","first-page":"9","article-title":"Maintaining bone health in patients with multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board","volume":"15","author":"Miceli","year":"2011","unstructured":"Miceli TSColson KFaiman BMMiller KTariman JD, International Myeloma Foundation Nurse Leadership Board. Maintaining bone health in patients with multiple myeloma: survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. 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J Neurosurg Spine. 2012;16(4):379-386."},{"issue":"4","key":"bib24","series-title":"Acta Radiol","first-page":"369","article-title":"Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up","volume":"47","author":"Pflugmacher","year":"2006","unstructured":"Pflugmacher RKandziora FSchroeder RJMelcher IHaas NPKlostermann CK. Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up. Acta Radiol. 2006;47(4):369-376."},{"issue":"2","key":"bib25","series-title":"J Neurosurg Spine","first-page":"211","article-title":"Bilateral paraspinal muscle flap closure technique for reduction of wound complications from posterior thoracolumbar spinal fusion: results of a series of 716 patients","volume":"34","author":"Houten","year":"2021","unstructured":"Houten JKWeinstein GRCollins MJKomlos D. Bilateral paraspinal muscle flap closure technique for reduction of wound complications from posterior thoracolumbar spinal fusion: results of a series of 716 patients. J Neurosurg Spine. 2021;34(2):211-217."},{"issue":"5","key":"bib26","series-title":"Asian Spine J","first-page":"888","article-title":"The feasibility of multiple fixation points in C2","volume":"17","author":"Ngoc","year":"2023","unstructured":"Ngoc QNRiew KDLee SM, et al. The feasibility of multiple fixation points in C2. Asian Spine J. 2023;17(5):888-893."},{"issue":"12","key":"bib27","series-title":"Spine","first-page":"1008","article-title":"Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity","volume":"38","author":"Hostin","year":"2013","unstructured":"Hostin RMcCarthy IO\u2019Brien M, et al. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine. 2013;38(12):1008-1015."},{"issue":"11","key":"bib28","series-title":"Cureus","first-page":"e19421","article-title":"Sternotomy approach to the anterior cervicothoracic spine","volume":"13","author":"Fiani","year":"2021","unstructured":"Fiani BChacon DCovarrubias CSarno EKondilis A. Sternotomy approach to the anterior cervicothoracic spine. Cureus. 2021;13(11):e19421."},{"issue":"2","key":"bib29","series-title":"Eur Spine J","first-page":"257","article-title":"Posterior transpedicular corpectomy for malignant cervical spine tumors","volume":"19","author":"Eleraky","year":"2010","unstructured":"Eleraky MSetzer MVrionis FD. Posterior transpedicular corpectomy for malignant cervical spine tumors. 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J Arthroplasty. 2016;31(8):1645-1648."},{"issue":"2","key":"bib32","series-title":"Int Wound J","first-page":"112","article-title":"Radiotherapy and wound healing","volume":"2","author":"Dormand","year":"2005","unstructured":"Dormand ELBanwell PEGoodacre TE. Radiotherapy and wound healing. Int Wound J. 2005;2(2):112-127."},{"issue":"1","key":"bib33","series-title":"Radiat Oncol","first-page":"162","article-title":"Wound healing after radiation therapy: review of the literature","volume":"7","author":"Haubner","year":"2012","unstructured":"Haubner FOhmann EPohl FStrutz JGassner HG. Wound healing after radiation therapy: review of the literature. 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An integrated multidisciplinary algorithm for the management of spinal metastases: an International Spine Oncology Consortium report. Lancet Oncol. 2017;18(12):e720-e730."},{"issue":"5","key":"bib36","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Vertebral multiple myeloma with pathological fracture: the most common etiology for emergency spine surgery in patients with no cancer diagnosis on admission","volume":"50","author":"Burks","year":"2021","unstructured":"Burks JDElarjani TJamshidi AMGovindarajan VLevi AD. Vertebral multiple myeloma with pathological fracture: the most common etiology for emergency spine surgery in patients with no cancer diagnosis on admission. Neurosurg Focus. 2021;50(5):E2."},{"issue":"6","key":"bib1","series-title":"Am Fam Phys","first-page":"373","article-title":"Multiple myeloma: diagnosis and treatment","volume":"95","author":"Michels","year":"2017","unstructured":"Michels TCPetersen KE. Multiple myeloma: diagnosis and treatment. 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