Results of a recent study suggest that balloon kyphoplasty provides better pain relief and more back-specific mobility one month after treatment than non-surgical care in multiple myeloma patients and other cancer patients with spinal fractures.

Based on these findings, the study authors suggested that balloon kyphoplasty be considered as an early treatment option for cancer patients with vertebral compression fractures.

One of the hallmarks of multiple myeloma is bone disease, which is noted by bone pain, bone fractures or lesions, and increased calcium levels. Myeloma bone disease often causes bone loss or weakening, which may result in bone fractures in the spine due to compression of the vertebrae. These vertebral compression fractures may cause back pain, partial paralysis of limbs, decreased sensation, and poor urinary control.

Patients with spinal fractures may be treated with non-surgical methods, such as medication and bed rest to reduce pain, back braces and walking aids to improve functional ability, and anti-bone degradation therapy to prevent future fractures.

However, there are several disadvantages to treating spinal fractures exclusively with non-surgical practices, including limitations in efficacy and serious side effects that accompany some pain-relieving medications.

As a result, researchers are currently investigating whether vertebral compression fractures can be treated more effectively and safely with a surgical procedure known as balloon kyphoplasty ^[1]. During the procedure, a small balloon is inserted into the fractured vertebra and inflated, creating a space that is later filled with an acrylic cement to stabilize and strengthen the vertebral structure.

The study included 134 cancer patients, 49 of whom had multiple myeloma. The patients were randomly assigned to receive treatment with balloon kyphoplasty or non-surgical methods. Patients who received non-surgical care had the opportunity to undergo balloon kyphoplasty after one month of non-surgical care.

In order to assess changes in a patient’s back-specific mobility, researchers used a 24-point questionnaire called RDQ. A score of 0 indicated no disability, whereas a score of 24 signified maximum disability.

At one month, the average RDQ score for patients assigned to the kyphoplasty group improved from 17.6 to 9.1, whereas the average RDQ score for patients assigned to the non-surgical care group did not change significantly (from 18.2 to 18.0).

The researchers also found that patients treated with kyphoplasty experienced a significant improvement in back pain seven days after the procedure, which continued through the one-month assessment mark. At one month, fewer patients in the kyphoplasty group used medication for pain relief than in the non-surgical care group.

Researchers also evaluated the patient’s ability to care for oneself. Of the patients treated with kyphoplasty, 75 percent had scores that indicated an ability to care for oneself, compared to 39 percent of the patients treated with non-surgical methods.

Patients in the kyphoplasty treatment group additionally reported improvement in quality of life. 

Of the patients who received non-surgical treatment, 73 percent opted to cross over to the kyphoplasty treatment group. These patients had similar outcomes to the original kyphoplasty group.

The most common side effects experienced within the first month include back pain and symptomatic spinal fractures. The rate of side effects was comparable for both treatment groups.

Although the study’s findings suggest that balloon kyphoplasty improves functional ability and back pain, the study authors pointed out that the significance of their findings is somewhat limited because the patients who received non-surgical care could cross over to the kyphoplasty treatment group after one month of treatment.

According to the study authors, however, the long-term effects of kyphoplasty can only be assessed in a controlled clinical trial that does not allow for patient cross over, which is unlikely to be conducted with cancer patients with limited life expectancy.

For more information on the study, please see the journal The Lancet ^[2] (abstract).