Classically a lateral X-ray of the skull will show typical punched out areas.

The spine may show osteolytic areas affecting the vertebral bodies, laminae and pedicles. This may cause collapse of the spine and paraplegia. The intervertebral discs are always spared.

Pathological and potential pathological fractures due to multiple myeloma, as with fractures due to secondaries from carcinoma, require stabilisation. As already mentioned, these secondary deposits are extremely vascular, and adequate blood transfusion should always be available for the operation. The addition of bone cement will usually both help stabilise the fracture as well as stop most of the haemorrhage.