The Role of Cement Augmentation with Percutaneous Vertebroplasty and Balloon Kyphoplasty for Treatment of Vertebral Compression Fractures in Multiple Myeloma: A Consensus Statement from the International Myeloma Working Group
Multiple myeloma (MM) patients often experience bone involvement, leading to painful vertebral compression fractures (VCFs) and deformities. Balloon kyphoplasty (BKP) and percutaneous vertebroplasty (PV) are minimally invasive procedures that can relieve pain and restore function in MM patients with VCFs. Indications for cement augmentation include persistent significant pain, significant change in disability, and acute patient-delayed for medical reasons. Cement augmentation should be performed within 4-8 weeks of VCFs. The maximum number of levels that should be augmented at a time is 3, and caution should be taken when treating more levels to avoid complications such as cement embolus to the lungs. BKP is better than PV or non-surgical management in reducing disability, pain, and subsequent fracture risk in MM patients with VCFs. Radiotherapy should be used judiciously and sparingly. Bisphosphonate therapy can help stabilize bone density and provide an external scaffold of bone that stabilizes the vertebral bodies in MM patients. Cement augmentation is an effective way to stabilize the anterior and middle spinal columns without the need for metalwork fixation, reducing the risk of infection in immunocompromised patients. The mechanisms of bone destruction in multiple myeloma and the risk factors for vertebral fractures are discussed. Vertebral fractures impact quality of life and functional status, and hyperkyphosis is associated with mortality in older women.
Important points:
- MM patients experience bone involvement and VCFs.
- BKP and PV can relieve pain and restore function in MM patients with VCFs.
- Indications for cement augmentation include persistent significant pain and change in disability.
- Cement augmentation should be performed within 4-8 weeks of VCFs.
- Caution should be taken when treating more than 3 levels to avoid complications.
- BKP is better than PV or non-surgical management in reducing disability, pain, and subsequent fracture risk.
- Radiotherapy should be used judiciously and sparingly.
- Bisphosphonate therapy stabilizes bone density and provides an external scaffold of bone.
- Cement augmentation stabilizes the spinal columns without metalwork fixation.
- Mechanisms of bone destruction in multiple myeloma and risk factors for vertebral fractures are discussed.
- Vertebral fractures impact quality of life and functional status.
- Hyperkyphosis is associated with mortality in older women.
Authors:
Kyriakou C, Molloy S, Vrionis F, Alberico R, Bastian L, Zonder JA, Giralt S, Raje N, Kyle RA, Roodman DGD, Dimopoulos MA, Rajkumar SV, Durie BBG, Terpos E.
Citation:
Kyriakou et al. Blood Cancer Journal ( 2019) 9:27
https://doi.org/10.1038/s41408-019-0187-7