Pain reduction after percutaneous vertebroplasty for myeloma-associated vertebral fractures

INTRODUCTION: Percutaneous vertebroplasty (PVP) is a minimally invasive procedure with cement augmentation of vertebral fractures. It was introduced in 1987 as a treatment for painful haemangiomas and is today mostly used for painful osteoporotic fractures of the spine. Two randomised, double-blinded trials published in 2009 have raised a debate about the efficiency of the PVP treatment. The aim of this study was to assess the safety and efficacy of PVP for vertebral body fractures in myeloma patients.

METHODS: A consecutive group of patients with multiple myeloma who underwent PVP were reviewed. A total of 64 levels were treated on 17 patients during 24 sessions. All procedures were performed in local anaesthesia; no patients complained about discomfort during the procedure.

RESULTS: The median preoperative visual analogue scale (VAS) score was 7.6. Improvement was observed in all patients. The median VAS pain score decreased to 3.2 at the three-month follow-up. The results are statistically significant. No complications were observed either during or after the treatment. We observed cement leakage in 12.5% of the patients, but no patients with cement leakage had clinical symptoms.

CONCLUSION: PVP is a safe and efficient procedure in the treatment of painful vertebral fractures in patients with multiple myeloma. The main advantages are the immediate stabilisation of the fractured vertebral body, reduction of the pain level and the fact that the patient can be discharged after two hours. The procedure can be repeated for several levels, and the pain relieving effect seems to be permanent.

FUNDING: not relevant.

TRIAL REGISTRATION: not relevant.