According to a small Italian study, multiple myeloma patients being treated for spinal fractures face a slightly lower risk of cement leakage following kyphoplasty compared to vertebroplasty.

Additionally, the Italian researchers found that several factors, including thicker cement, prior treatment with bone marrow transplantation, and injecting no more than 2 mL of cement regardless of the number of vertebrae being treated, are associated with a lower leakage risk.

Based on these findings, the researchers consider both vertebroplasty and kyphoplasty safe treatment options for myeloma-related spinal lesions. However, they point out that the risk factors associated with cement leakage should be taken into account before deciding on the best course of treatment for a given patient.

Bone lesions and fractures are frequently observed in myeloma patients, with spinal fractures being the most common. These fractures can lead to severe back pain, loss of mobility, and spinal deformation. Currently available treatment options include radiation therapy, which reduces pain, or minimally invasive procedures such as vertebroplasty and kyphoplasty. 

Vertebroplasty involves injecting bone cement directly into the spinal fracture site, which provides pain relief and stabilizes the spine. In kyphoplasty, a balloon is inserted into the fractured bone and inflated to create a void, which is then filled with cement.  Similar to vertebroplasty, kyphoplasty can relieve pain and provide support, but it can also restore height (see Beacon related news). Both procedures allow patients to return to daily activities within one day.

The most common complication of both vertebroplasty and kyphoplasty is cement leakage, which can lead to more severe complications including nerve damage, infection, and blood clots.

According to researchers at the Gaetano Pini Orthopaedic Institute in Milan, Italy, there is currently little data available regarding the risk of cement leakage following vertebroplasty and kyphoplasty in myeloma patients.

In order to evaluate risk of cement leakage and to identify the factors associated with a lower risk, the researchers retrospectively analyzed records from 14 multiple myeloma patients who had received vertebroplasty and/or kyphoplasty at their institution between November 2005 and May 2008.

The average patient age was 63 years. A total of 37 fractured vertebrae were repaired.

Of the 14 patients included in the analysis, 43 percent underwent both procedures, another 43 percent were treated using only kyphoplasty, and 14 percent were treated with only vertebroplasty. The rates of leakage following the operations were observed through standard x-rays and CT scans.

Overall, 43 percent of patients had cement leakage; of those, 67 percent received treatment with vertebroplasty for multiple vertebrae and 33 percent received kyphoplasty.

When the rate of leakage was based on the number of treated vertebrae, the researchers found that 24 percent of the treated vertebrae leaked. The vertebrae treated through kyphoplasty had a slightly lower rate of leakage (21 percent), compared to those treated through vertebroplasties (28 percent).

Eighty percent of the leaking vertebrae treated with vertebroplasty occurred in patients receiving vertebroplasty at multiple vertebrae.

Furthermore, of the patients who underwent vertebroplasty at multiple vertebrae and showed leakage, none had undergone a prior bone marrow transplant. Conversely, patients who received a bone marrow transplant before undergoing vertebroplasty at multiple vertebrae did not have any leakage.

Out of the leaking vertebrae treated by kyphoplasty, 75 percent received cement from two sides of the vertebrae, while 25 percent had cement injected from one side. The researchers pointed out that a greater overall volume of cement is used when injected from two sides, which may explain the higher leakage rate.

Prior studies have suggested that thicker cement is associated with a reduced leakage rate. The researchers pointed out that thin bone cement was used in this study and that the use of thicker cement may have led to better results.

None of the patients who showed leakage demonstrated any leakage-related symptoms.

For more information, please see the study in the European Spine Journal (abstract).