As treatments for multiple myeloma (MM) have improved, people with the disease are living longer. Because as many as 70% of them develop vertebral metastasis and pathological vertebral fractures (PVF), there’s a greater need for options to manage their pain and associated disability.

A team of researchers launched a comprehensive multidatabase search and reviewed 23 clinical studies to create an updated synthesis of knowledge used in vertebral augmentation, including percutaneous vertebroplasty (PV) and balloon kyphoplasty (BKP), for patients affected by MM-related PVF.  Their narrative review was published in European Spine Journal.  

After reviewing the 23 studies, the researchers found that patients who were treated with PV and BKP experienced significant pain relief and functional improvements on a variety of measures including the Eastern Cooperative Oncology Group scale, the Neck Pain Disability Index, the Cervical Spine Function score, Oswestry Disability Index, and others.


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“With life expectancy improvement of MM patients, the need to manage pain and pain-associated disability from [myeloma bone disease] is increasingly a high priority,” the researchers wrote. “Vertebral augmentation, including PV and BKP, is a safe and effective procedure that offers pain relief, reduction in pain-associated disability, and reduction of fracture incidence.”

Another benefit is the minimally invasive nature of vertebral augmentation, which makes it a viable option for frail patients.

The researchers noted that complications were documented in the literature, most notably cement leakage. The rates ranged from 0% to 15.8% for PV and 0% to 60% for BKP.

The limitations cited in this review included that no randomized clinical trials were included so the possibility of selection and recall bias can’t be ruled out. The researchers couldn’t perform a statistical analysis because of the heterogeneity of patient-reported outcome measures. Most of the studies involved short-term outcomes. Future research should expand the focus to obtain long-term data.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Onggo JR, Maingard JT, Nambiar M, Buckland A, Chandra RV, Hirsch JA. Role of vertebroplasty and balloon kyphoplasty in pathological fracture in myeloma: a narrative review. Eur Spine J. Published online August 14, 2021. doi:10.1007/s00586-021-06955-5