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

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Abstract

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.

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Authors and Affiliations

  1. Neuro-Interventional Radiology Unit, Monash Imaging Monash Health, Clayton, VIC, Australia

    James Randolph Onggo, Julian T. Maingard, Mithun Nambiar & Ronil V. Chandra

  2. Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia

    James Randolph Onggo, Mithun Nambiar & Ronil V. Chandra

  3. Faculty of Medicine, Deakin University, Waurn Ponds, Geelong, Australia

    Julian T. Maingard

  4. Department of Orthopaedic Surgery, Spine Research Center, NYU Langone Health, New York, USA

    Aaron Buckland

  5. Melbourne Orthopaedic Group, Melbourne, Australia

    Aaron Buckland

  6. Spine and Scoliosis Research Associates Australia, Melbourne, Australia

    Aaron Buckland

  7. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Joshua A. Hirsch

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  1. James Randolph Onggo
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  2. Julian T. Maingard
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  6. Joshua A. Hirsch
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Contributions

JRO contributed to idea conception, the literature search, figures and tables, data consolidation, manuscript writing and editing. JM was involved in idea conception, data consolidation, manuscript editing and finalisation. MN contributed to the literature search, manuscript writing and editing. AB was involved in data consolidation, manuscript editing and finalisation, RVC contributed to idea conception, manuscript editing and finalisation. JAH was involved in idea conception, the literature search, manuscript editing and finalisation.

Corresponding author

Correspondence to James Randolph Onggo.

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Conflict of interest

Prof Hirsch is a consultant for Medtronic, Relievant and Persica. He is also a grant recipient of the Neiman Health Policy Institute. However, these involvements do not result in any conflict of interest with this article. All other authors certify that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licencing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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This work was primarily performed in Box Hill Hospital, Victoria, Australia.

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Onggo, J.R., Maingard, J.T., Nambiar, M. et al. Role of vertebroplasty and balloon kyphoplasty in pathological fracture in myeloma: a narrative review. Eur Spine J 30, 2825–2838 (2021). https://doi.org/10.1007/s00586-021-06955-5

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