Role of vertebroplasty and balloon kyphoplasty in pathological fracture in myeloma: a narrative review

Background Up to 70% of multiple myeloma (MM) patients develop vertebral metastasis and subsequent pathological vertebral fractures (PVF). With contemporary systemic therapies, life expectancy of MM patients has improved drastically, and the need to manage pain and associated disability from PVF is...

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Bibliographic Details
Published in:European spine journal 2021-10, Vol.30 (10), p.2825-2838
Main Authors: Onggo, James Randolph, Maingard, Julian T., Nambiar, Mithun, Buckland, Aaron, Chandra, Ronil V., Hirsch, Joshua A.
Format: Article
Language:English
Subjects:
Analgesia
Balloon treatment
Bone surgery
Fractures
Life span
Medicine
Medicine & Public Health
Metastases
Morbidity
Multiple myeloma
Neurosurgery
Pain
Pain perception
Patients
Review Article
Spine (cervical)
Surgical Orthopedics
Vertebrae
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Summary:Background Up to 70% of multiple myeloma (MM) patients develop vertebral metastasis and subsequent pathological vertebral fractures (PVF). With contemporary systemic therapies, life expectancy of MM patients has improved drastically, and the need to manage pain and associated disability from PVF is increasingly a high priority. The aim of this review is to provide an updated comprehensive synthesis of evidence in the use of vertebral augmentation, including percutaneous vertebroplasty (PV) and balloon kyphoplasty (BKP), to treat MM-related PVF. Methods A comprehensive multi-database search in accordance with PRISMA guidelines was performed up to 10 February 2021. Relevant English language articles were selected and critically reviewed. Findings A total of 23 clinical studies have been included in the review. PV and BKP showed significant pain and functional improvements in terms of analgesia requirements, Cervical Spine Function Score, Eastern Cooperative Oncology Group scale, EQ-5D score, Karnofsky score, Neck Pain Disability Index, Oswestry Disability Index, Short form-36 (SF-36) questionnaire and VAS pain scale. Both procedures also reported promising radiographic outcomes in terms of vertebral height improvement, maintenance and restoration, as well as kyphotic deformity correction. Asymptomatic cement leakage was commonly reported. There was no significant difference between the two procedures. Conclusion PV and BKP are safe and effective procedure that offers pain relief, reduction in pain associated disability and reduction of fracture incidence. Its minimally invasive approach is associated with minimal morbidity risk, making it a viable option in frail patients. Level of evidence IV Narrative review.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-021-06955-5