Vertebroplasty in multiple myeloma: outcomes in a large patient series

Abstract

Background and purpose: Despite the literature supporting the efficacy of vertebroplasty for treatment of osteoporotic vertebral compression fractures, few reports exist documenting its use in the treatment of compression fractures in multiple myeloma patients. Accordingly, we sought to characterize the imaging characteristics, clinical course, and outcomes in myeloma patients treated with vertebroplasty.

Materials and methods: We performed a retrospective review of clinical outcome data from 67 multiple myeloma patients treated with vertebroplasty since October 2000. Quantitative outcome data including the Roland Morris Disability Questionnaire (RDQ) and Visual Analog Scales for pain and qualitative outcome data (self-reported pain, mobility, and narcotic use) were collected preoperatively, immediately after vertebroplasty, and at 1 week, 1 month, 6 months, and 1 year after treatment.

Results: Significant improvements in all of the outcome measures were observed postoperatively and throughout the duration of follow-up. Quantitative outcome measures (RDQ, analog pain scale 0-10, with rest and activity) improved by 11.0 (48%; P < .0001), 2.7 (25%; P < .001), and 5.3 (48%; P < .0001) points, respectively, with persistent improvement at 1 year (P < .01; P < .03; P < .001). Eighty-two percent and 89% of patients experienced a significant improvement in subjective rest pain and activity pain, respectively. Subjective scores achieved durable improvements, with 65% of patients requiring fewer narcotics after vertebroplasty and 70% having improved mobility.

Conclusion: Vertebroplasty provides significant and durable pain relief for patients with intractable spinal pain secondary to compression fractures resulting from multiple myeloma.

Fig 1.

Sagittal T1 MR imaging demonstrating fracture types. Stars indicate treated fractures. A, Type 1 fracture, considered probably osteoporotic in nature. Areas of preserved, high T1 signal intensity within the fractured vertebral body, without focal intravertebral lesion and no evidence for pedicle involvement or epidural or paraspinal disease (not shown). B, Type 2 fracture, indeterminate for underlying lesions. Diffusely low signal intensity marrow throughout the spine. No focal lesion or epidural or paraspinal lesion within the treated vertebral body. C, Type 3 fracture, with clear evidence for myelomatous lesion within the treated vertebral body.

Fig 2.

Treated and affected levels. Vertebral level frequency histograms of 114 treated vertebral levels (A) and 216 affected vertebral levels (B) in the 67 patients composing the myeloma study population. Diffuse myeloma involvement (>10 vertebral bodies) was not included in this histogram.

Fig 3.

Time to treatment. Time to treatment of myeloma study participants is shown as a function of a frequency histogram with each bin representing a 4-month period.

Fig 4.

Objective clinical outcome scores over time. Mean (± SD) RDQ and analog pain scale (pain with rest and activity) scores are shown preoperatively (baseline), postoperatively, and 1 week, 1 month, 6 months, and 1 year after vertebroplasty.