The outcome of expandable titanium mesh implants for the treatment of multi-level vertebral compression fractures caused by multiple myeloma.

Saud Alhamad,Abdurrahman Islim,Sathya Thambiraj,Surya Gandham

doi:10.1051/sicotj/2021026

Saud Alhamad, Abdurrahman Islim + Show 2 more

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https://doi.org/10.1051/sicotj/2021026

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Abstract

Background: Painful vertebral compression fractures (VCFs) in myeloma patients severely reduce quality of life. Currently, the International Myeloma Working Group (IMWG) and National Institute of Clinical Excellence NICE advocate the use of either balloon kyphoplasty or vertebroplasty in the management of these fractures. Methods: All patients with VCFs and myeloma who adhered to the IMWG indications for vertebral augmentation were treated with the Osseofix® implant. Visual analogue scores (VAS) and Oswestry disability index (ODI) were taken preoperatively and at least one year following surgery. Cobb angle and implant migration were measured on lateral standing radiographs. Results: Sixteen patients (average age 62, SD = 11.6) consisting of 82 levels (range 3–8) were stabilised with no perioperative complications or revisions at one year. There was an improvement in patient-reported outcomes with the median preoperative VAS of 8.6 (IQR 7.3–10.0) reducing to 3 (IQR 1.0–4.0) after one year (P < 0.001) whilst an average improvement of 31.4 (SD = 19.6) points in the ODI scores was reported (P < 0.001). There was no significant collapse or implant failure at one year with a greater improvement in the VAS/ODI score, when more implants were used (P = 0.049 and 0.008, respectively). The average length of stay was 2.2 days (SD = 1.7). Conclusion: The use of the Osseofix® implant in VCFs caused by multiple myeloma has shown a statistically significant improvement in both pain and outcome scores. There were no complications or significant radiological deterioration of spinal alignment over the course of a year.

Highlights

Multiple myeloma (MM) is a clonal B-cell disorder characterised by proliferation and accumulation of B-lymphocytes and plasma cells in the bone marrow and has an incidence of 6/ 100,000 in western populations [1]
The increased number of implants used was predictive of Oswestry disability index (ODI) (B-coefficient À4.29 [95% CI À7.29 to À1.29], p = 0.008) and Visual analogue scores (VAS) (B-coefficient À0.48 [95% CI À0.97 to À0.002], p = 0.049) improvement (Table 3)
The average vertebral compression ratio (VCR) correction was 1.5% (SD = 3.2) and there was no association between VCR and VAS or ODI

Summary

Introduction

Multiple myeloma (MM) is a clonal B-cell disorder characterised by proliferation and accumulation of B-lymphocytes and plasma cells in the bone marrow and has an incidence of 6/ 100,000 in western populations [1]. MM has a predilection for the spine due to the high hematopoietic marrow content of the vertebrae and offers an ideal site for local infiltration and growth of neoplastic plasma cells [2]. Osteoclasts are preferentially activated and the homeostatic balance of bone remodelling shifts towards resorption [3]. This leads to localised osteoporosis and may lead to vertebral compression fractures (VCFs).

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