Kyphoplasty for spinal fractures from multiple myeloma.

INTRODUCTION

Vertebral destruction secondary to multiple myeloma is a significant clinical issue, and controversy still exists over how many levels should undergo kyphoplasty in multiple myeloma. In addition, in vertebrae that have lost wall integrity, cement extravasation remains an important consideration and is relatively contraindicated.

METHODS

Forty-three symptomatic vertebral fractures from multiple myeloma were diagnosed by magnetic resonance imaging (MRI). In levels with anterior vertebral wall compromise, two distinct sequential applications of cement were performed. In levels with demonstrated posterior or lateral wall deficiency, cement was injected under fluoroscopy.

RESULTS

All patients tolerated the procedure well and had immediate relief of back pain after kyphoplasty. Symptomatic cement extravasation and other complications were not observed. Vertebral height was restored (anterior 56.9 +/- 14.2% to 82.9 +/- 11.2%, middle 71.0 +/- 13.4% to 81.1 +/- 6.4%) (P < 0.001), and the mean kyphotic angle was improved (17.1 +/- 7.2 degrees to 8.9 +/- 6.4 degrees ) (P < 0.001). The mean VAS decreased significantly from presurgery to postsurgery (8.1 +/- 1.5 to 3.6 +/- 1.8) (P < 0.001), as did the ODI (63.2 +/- 15.9 to 37.1 +/- 10.2) (P < 0.001). Six of eight subscores measured by the SF-36, were significantly improved by the operation. All improvements were sustained up to final follow-up.

CONCLUSION

Kyphoplasty is a safe and clinically effective treatment for pathologic vertebral fractures from multiple myeloma, even in levels with vertebral wall deficiency. The strategy of determining systematic level by alterations in MRI signal is effective in lowering the cost.