Kyphoplasty for Patients With Multiple Myeloma is a Safe Surgical Procedure: Results From a Large Patient Cohort

Franz-Xaver Huber; Nicholas McArthur; Michael Tanner; Bernd Gritzbach; Oliver Schoierer; Wolfram Rothfischer; Gerhard Krohmer; Erich Lessl; Martin Baier; Peter Jürgen Meeder; Christian Kasperk

Disclosures

Clin Lymphoma Myeloma. 2009;9(5):375-380. 

In This Article

Abstract and Introduction

Abstract

Introduction: Only in recent years has balloon kyphoplasty gained significance in the treatment of vertebral fractures as an adequate minimally invasive vertebral stabilization technique. Kyphoplasty has also increasingly been used to treat vertebral osteolyses caused by multiple myeloma (MM).
Patients and Methods: In our cohort of 76 patients with MM with a total of 190 vertebral fractures treated with kyphoplasty, we performed a 30-day postoperative analysis of cement leakage, neurologic symptoms, pulmonary embolism, and infections.
Results: Painful osteolytic or fractured vertebrae or even imminent vertebral instability caused by osteolyses were seen as indications for kyphoplasty. One case of pulmonary embolism was observed because of cement leakage as the only postoperative complication.
Conclusion: By careful interdisciplinary indication setting and a standardized treatment model, kyphoplasty presents a very safe and effective procedure for the treatment of vertebral osteolyses and fractures caused by MM.

Introduction

Balloon kyphoplasty has been only recently considered an established operative procedure in the treatment of vertebral fractures. The first successful application of a similar procedure, ie, vertebroplasty was published in France by Deramond et al in 1987 in a patient who suffered a vertebral fracture from osteolysis caused by multiple myeloma (MM).[1,2] In contrast to vertebroplasty, kyphoplasty restores vertebral body height and spinal alignment in the sagittal plane by first creating a void in the fractured vertebra with the help of an inflatable balloon and then filling this void with an injection of poly(methylmethacrylate) (PMMA) or absorbable calcium phosphate.[3,4,5,6,7,8,9] The aim of balloon kyphoplasty in patients with MM is pain relief and stabilization of fractured and osteolytic vertebrae.[3,5,6,7,9]

Cement leakage through the vertebral body boundaries is the most frequently described complication of kyphoplasty and is rarely related to clinical manifestations.[10] Nevertheless, such manifestations include paraplegia and pulmonary embolism.[11,12] Other complications include local or systemic reactions to the cement.[13]

In our cohort of 76 patients treated with a total of 190 kyphoplasties, we performed a 30-day postoperative analysis of cement leakage, neurologic symptoms, allergic reactions, pulmonary embolism, and infections. Patient characteristics are presented in Table 1. Our indication setting for kyphoplasty was applied to painful osteolytic or fractured vertebrae or even imminent vertebral instability caused by osteolyses of MM.

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