Kyphoplasty in the treatment of vertebral fractures secondary to multiple myeloma

Abstract

Sean Dudeney, MD, Mohamed Hussein, MD, Isador H. Lieberman, MD, Cleveland, OH, USABackground context: We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction. The spine is the most affected skeletal structure. Vertebral involvement results in compression fractures that give rise to severe pain and progressive kyphosis. Present treatment includes bed rest, analgesics and bracing, which result in further bone resorption. Antimyeloma therapy controls the disease but does not provide significant structural relief. Augmentation of vertebral compression fractures with polymethylmethacrylate, that is, vertebroplasty, has been used with success to treat pain. This technique does not attempt to restore the height of the collapsed vertebral body and has high cement leakage rates. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement, resulting in lower leakage rates.Methods: Forty-five consecutive kyphoplasty procedures were performed in 15 patients with vertebral compression fractures resulting from multiple myeloma over 22 sessions. Comparing preoperative and latest SF36 scores made objective analysis. Height restoration was estimated by measuring vertebral height on pre- and postoperative lateral radiographs. Cement leakage and any complications were recorded prospectively.Results: The mean age of patients was 63 years (range, 48 to 79 years), and the mean duration of symptoms was 5.8 months, mean follow-up of 4.9 months. Levels treated ranged from T6 to L5 (T11=6, T12=6, L1=7). There were no major complications related directly to use of this technique or use of the inflatable bone tamp. On average, 28% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at 2 of 45 levels (4%). Significant improvement in SF36 scores occurred for bodily pain (22.6 to 55.0; p=.002) and physical function (19.3 to 50.7; p=.0023), as well as vitality (30.7 to 48.9; p=.022), social functioning (38.4 to 64.3; p=.016) and mental health (59.1 to 76.3; p=.048).Conclusion: The kyphoplasty balloon bone tamp was efficacious in the treatment of vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is a well-tolerated procedure associated with early clinical improvement of pain and function as well as some restoration of vertebral body height in these patients. Restoration of a functional spine is of ever increasing importance as improvements in medical management increases survival in multiple myeloma.