The efficacy of vertebral augmentation to treat osteoporotic vertebral compression fractures has been well described, but there have been few reports focusing on the treatment of non-osteoporotic vertebral compression fractures (NOVCF) in patients with Multiple Myeloma (MM). We sought to characterize the imaging features, clinical course, and outcomes of vertebral compression fractures treated with vertebroplasty (VP) and kyphoplasty (KP) in patients with MM.
Materials and Methods
792 consecutive patients with MM (45% female, mean 63 years) referred to a single center for the treatment of NOVCF between January 2001 and May 2007 were prospectively enrolled into the IRB-approved study. Pre-procedure and post-procedure imaging characteristics, pain (visual analog scale, VAS), medication usage, mobility, and disability and were recorded in a central database. Procedural complications and the development of subsequent NOVCF were ascertained from review of each patient's medical record. Statistical analysis was performed using SPSS, Chicago, IL.
Results
2,715 non-osteoporotic vertebral compression fractures were treated during 904 VP procedures and 183 KP procedures in 792 patients with MM. Compression fractures occurred most frequently at the thoracolumbar junction with T12, L1, and L2 accounting for 31.6% of treated levels (T1-T5:7.4%, T6:4.8%, T7:6.0%, T8:7.0%, T9:6.2%, T10:5.9%, T11:8.3%, T12:10.8%, L1:10.9%, L2:9.9%, L3:9.5%, L4:7.5%, and L5:5.7%). A statistically significant reduction in VAS was observed (7.0 mean pre-procedure VAS vs. 2.7 mean post-procedure VAS, p<0.001). 293 patients (37%) reported a decrease in medication usage, 491 (62%) had no change and 8 (1%) patients reported an increase in medication usage. 380 patients (48%) reported an improvement in their post-procedural activity level, and 657 (83%) would consider vertebroplasty or kyphoplasty again if needed. Complications were infrequent.
Conclusion
Our study represents the largest reported experience in the treatment of non-osteoporotic compression fractures in patients with Multiple Myeloma. Vertebral augmentation resulted in a reduction of pain, medication usage, and disability.
University of Arkansas for Medical Sciences, Little Rock, AR
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