Medical and Scientific Director
Institute for Myeloma and Bone Cancer Research
CEO, Oncotherapeutics
West Hollywood, California
What’s new in the management of vertebral compression fractures?
The most common clinical manifestation of myeloma remains bone disease. It is most often manifest as fractures. The most common site is the vertebral bodies and as a result there has been an increasing focus on how to deal with those fractures. In the past, this was done with very cumbersome and very poorly tolerated major operative procedures. In the last decade, a number of procedures have been developed that are minimally invasive, starting first with vertebroplasty, and more recent, kyphoplasty. Vertebroplasty involves the placement of a needle in the collapsed vertebral body and cement is placed to stabilize the fracture, reducing the bone pain and improving the quality of life for the patient. More recently, this has been largely replaced by kyphoplasty, which a needle is placed in the collapsed vertebral body but instead of simply shoving cement in there, there is a balloon at the end of the needle that is expanded so the vertebral body can be expanded, there is an empty cavity in which cement can be placed. This seems to result in less side effects including extravasation outside of the vertebral body of the cement and even embolization to the lung which, may occur rarely, but also may improve the quality of the response in terms of reduction in bone pain and also improvement in the patient’s quality of life overall.
We now have results of a large randomized study in cancer patients with vertebral compression fracture, about a third of whom had myeloma, those patients randomized to immediate kyphoplasty and the other half had a delay for one month. And before the randomization at one month in which patients could be crossed over on the nonsurgical arm to receive kyphoplasty, at the one month time point, those who had kyphoplasty had a marked improvement in their back pain, a marked improvement in what it is called the Roland-Morris disability scale, they had better quality of life than those patients who had nonsurgical management. So, this seems to reduce bone pain, improve quality of life; and now, today we are beginning to recognize the importance of dealing with these fractures early. We used to wait and patients would experience pain because we were afraid dealing with the fracture would delay our treatment of the underlying myeloma. With these minimally invasive procedures, you can have ongoing treatment of the myeloma while you dealing with the fracture as well. So, it is important to remember there are now new procedures that are having major impact in a beneficial way on patients who have vertebral compression fractures.
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