The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG)

Abstract

Multiple myeloma (MM) represents approximately 15% of haematological malignancies and most of the patients present with bone involvement. Focal or diffuse spinal osteolysis may result in significant morbidity by causing painful progressive vertebral compression fractures (VCFs) and deformities. Advances in the systemic treatment of myeloma have achieved high response rates and prolonged the survival significantly. Early diagnosis and management of skeletal events contribute to improving the prognosis and quality of life of MM patients. The management of patients with significant pain due to VCFs in the acute phase is not standardised. While some patients are successfully treated conservatively, and pain relief is achieved within a few weeks, a large percentage has disabling pain and morbidity and hence they are considered for surgical intervention. Balloon kyphoplasty and percutaneous vertebroplasty are minimally invasive procedures which have been shown to relieve pain and restore function. Despite increasing positive evidence for the use of these procedures, the indications, timing, efficacy, safety and their role in the treatment algorithm of myeloma spinal disease are yet to be elucidated. This paper reports an update of the consensus statement from the International Myeloma Working Group on the role of cement augmentation in myeloma patients with VCFs.

Management of patients with multiple myeloma in the era of COVID-19 pandemic: a consensus paper from the European Myeloma Network (EMN)

“…Severe anemia and renal failure may necessitate hospitalization and immediate initiation of antimyeloma treatment along with supportive care [22]. Spinal cord compression may necessitate immediate initiation of radiotherapy and/or orthopedic decompensation [40,41]. Orthopedic treatment of impeding fractures and radiotherapy for palliation of pain unresponsive to analgesics should not be postponed [40].…”

Multiple Myeloma Associated Bone Disease

“…A retrospective analysis, with 18 myeloma patients who underwent vertebroplasty prior to autologous stem cell transplant showed that vertebroplasty could be done without affecting peripheral blood stem cell collection and transplant [109]. The current recommendation in myeloma associated vertebral collapse is to consider vertebral augmentation if it causes moderate or severe pain, and particularly if it affects mobilization [110] This is supported by a recently published national guideline based on the GRADE-approach [111] recommending vertebral augmentation as treatment in patients with painful vertebral lesions and malignant hematologic disease [112].…”

Analysis of percutaneous kyphoplasty or short-segmental fixation combined with vertebroplasty in the treatment of Kummell disease

“…In theory, SSF + VP will provide a more effective fixation than PKP and therefore will also lead to better pain relief, but this is not the case. The reason may be because PKP provides sufficient stability to the vertebra and destroys the surrounding pain sensory nerves [19, 20].…”