Vertebral Augmentation in Patients with Multiple Myeloma: A Pooled Analysis of Published Case Series

O.A Khan,W Brinjikji,D.F Kallmes

doi:10.3174/ajnr.a3622

Abstract

Studies examining the efficacy of vertebroplasty and kyphoplasty in patients with vertebral fractures from multiple myeloma are limited. We sought to perform a systematic review of published case studies examining changes in pain, disability, and analgesic drug use in patients with multiple myeloma who have undergone vertebral augmentation. We performed a pooled analysis of published case series of vertebral augmentation in patients with multiple myeloma. Twenty-three studies (9 kyphoplasty, 12 vertebroplasty, and 2 of both) with data on 923 patients were identified from a PubMed search. Quantitative outcome data included the Visual Analog Scale, the Brief Pain Inventory, the Short Form 36 Health Survey, and the Owestry Disability Index. Time periods were consolidated into 3: postoperatively ≤1 week, 1 week to 1 year, and ≥1 year. Change in analgesic use was also studied. Data were compared by using nonparametric tests and matched t tests for temporally linked data. Patients achieved a decrease in pain across all consolidated time periods. Pain, as measured on a 10-point scale, decreased by 4.8 points up to 1 week, 4.6 points up to 1 year, and 4.4 points after a year (P < .001). Decrease in pain was apparent early after treatment and was sustained with time. Kyphoplasty and vertebroplasty were equally effective in reducing pain scores because differences between procedures for each time period were insignificant (P < .9 for <1 week, P < 1.0 for ≤1 year, and P < .9 for >1 year. Our analysis demonstrates that vertebral augmentation is effective in patients with multiple myeloma.

Highlights

BACKGROUND AND PURPOSEStudies examining the efficacy of vertebroplasty and kyphoplasty in patients with vertebral fractures from multiple myeloma are limited
Kyphoplasty and vertebroplasty were effective in reducing pain scores because differences between procedures for each time period were insignificant
Our analysis demonstrates that vertebral augmentation is effective in patients with multiple myeloma

Summary

MATERIALS AND METHODS

Study Identification A review of the literature was performed by using PubMed. “Vertebroplasty” or “Kyphoplasty and Myeloma” were used as controlled vocabulary, and descriptors were identified by using MeSH. Studies of vertebroplasty and/or kyphoplasty published in the English language were considered in patients with myeloma, with a minimum of 15 patients, and those that contained Ն1 of the following parameters: numeric pain assessment scores for pre- and postoperative pain (Visual Analog Scale, Brief Pain Inventory, Short Form 36 Health Survey), numeric Owestry Disability Index (ODI) assessment for preand postoperative disability, rate of cement leakage (as detected on CT and plain film), and change in patient analgesic drug use. We collected data on the following complications: infection, pulmonary embolism, myocardial infarction, subsequent vertebral body compression fractures at untreated levels, neurologic symptoms requiring revision surgery, and transient postoperative pain. For the purpose of descriptive and analytical analysis, mean scores were used (when unavailable, median scores were treated as means), and pain assessment from the Visual Analog Scale, the Short Form Health Survey 36, and the. Statistical significance was taken as a 2-tailed P value Ͻ .05

RESULTS

Week–1 year

Limitations

DISCUSSION

CONCLUSIONS