Spinal Compression Fracture – Beth Morgan Multiple Myeloma Treatment Blog

Starting some weeks back, I was experiencing lower back pain. It wasn’t getting better. It was getting worse! I report anything out of the ordinary to the research team (I’m in a phase I clinical trial), and had been doing so with regard to this ailment.

Since the pain was only getting worse over time, my doctor decided to order a PET scan so he could tell if there was some myeloma blowing up in there. I had that PET scan a little more than a week ago, and it was determined that there was a compression fracture at L5. As far as I know, I’ve never had a vertebral fracture before this.

I saw someone from neurology as a next step, and I decided I would take their advice and have kyphoplasty. That’s scheduled for Tuesday, the 26th. I’m really happy to be having that done, because it’s said that the majority of people in my situation get pain relief almost right away.

In the last several years, I’ve broken my shoulder, a rib, and now this. If I had to rank them in terms of which one hurt the most, I don’t think I could. Each one had its own unique brand of horribleness. The L5, though, affects just about everything I do, from walking to standing and sitting. It’ll be a relief to get the kyphoplasty done.

The procedure will be done in the Interventional Radiology Department so the doctor can watch his progress using fluoroscopy.

I’ll let you know how it goes.

I got this alert last night, and it may apply to myeloma patients who have had spinal compression fractures.

Balloon Kyphoplasty for Spinal Compression Fracture

At 1 month, kyphoplasty patients had significantly greater improvements in global quality of life, back pain, and function than did controls.

In vertebroplasty and kyphoplasty, two minimally invasive procedures for spinal compression fractures, cement is injected into damaged vertebrae to prevent further compression and to alleviate pain. In kyphoplasty, a balloon is inflated within the vertebra to restore normal height and shape, and cement is injected into the resulting cavity. Although both procedures have been in use for longer than a decade, few data support long-term safety and efficacy of either one. With funding from a kyphoplasty instrument manufacturer, researchers randomized 300 patients with one to three acute vertebral compression fractures (average duration, 6 weeks) to receive supportive care alone or supportive care plus balloon-assisted kyphoplasty.

When the groups were compared after 1 month of follow-up, kyphoplasty patients had significantly greater improvements in global quality of life, back pain, and function and reported significantly fewer days of restricted activity. During the next year, these differences between groups narrowed, with some (but not all) losing statistical significance. Adverse events were similar in the two groups, apart from two reversible perioperative complications and a nonsignificant trend toward more new vertebral fractures in the kyphoplasty group.

Comment: This nonblinded study provides additional evidence that kyphoplasty improves symptoms and function more rapidly than supportive management. Although short-term pain relief and earlier resumption of normal activities are important outcomes, more data on the long-term efficacy and safety of the procedure are needed. The authors of the current trial will collect another year of follow-up data, and other groups are conducting randomized studies to compare vertebroplasty to kyphoplasty or to sham procedures.

— Bruce Soloway, MD

Published in Journal Watch General Medicine April 7, 2009

Citations:
Wardlaw D et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): A randomised controlled trial. Lancet 2009 Mar 21; 373:1016. [Medline® Abstract]

Kallmes DF and Jarvik JG. Spinal augmentation research: FREE at last? Lancet 2009 Mar 21; 373:982. [Medline® Abstract]

The above message comes from “Journal Watch”, who is solely responsible for its content.

Tag: Spinal Compression Fracture

L5 Compression Fracture

Balloon Kyphoplasty for Spinal Compression Fracture