62 - Treatment of Osteolytic Vertebral Fractures due to Multiple Myeloma: R...

#62 Treatment of Osteolytic Vertebral Fractures due to Multiple Myeloma: Radiofrequency (RFK) Kyphoplasty vs Conservative Care

General Session: Advocacy of MIS

Presented by: R. Pflugmacher

Author(s):

R. Pflugmacher (1)
R. Bornemann (1)
T.R. Jansen (1)
K. Kabir (1)
D.C. Wirtz (1)

(1) Universitätsklinikum Bonn, Bonn, Germany

Abstract

Background: Radiofrequency Kyphoplasty (RFK) provides a minimally invasive procedure to treat vertebral compression fractures (VCF) due to osteoporosis, trauma or tumor. Painful osteolytic vertebral fractures due to multiple myeloma are often treated conservatively. Patients suffer from pain and immobilization.

There is still a controversy discussion how to treat osteolytic vertebral fractures. Conservative care is the default approach, despite lack of evidence. RFK uses ultrahigh viscosity cement to stabilize the fracture. The aims of this study were to compare RFK to conservative care and to evaluate two patient groups which were treated with RFK or conservatively. The control group of conservative care results by patients which denied a surgical intervention. All patients were followed for 6 months follow up. All patients were seen every six weeks.

Methods: Patients with painful osteolytic vertebral compression fractures due to multiple myeloma were all offered surgical treatment by RFK.

Patients which agreed were treated within 3 days, patients which denied were treated conservatively (analgesics, bracing and physiotherapy). They were then offered the choice of continuing conservative care or crossing over to radiofrequency kyphoplasty, after 6 and 12 weeks. All patients, in the RFK or conservative care group, were treated by the oncologist and received chemotherapy when necessary.

Clinical success was defined as: 1) VAS pain improvement ≥ 2,0) final VAS pain ≤ 5,0) no functional worsening on ODI.

90 patients (51 females and 39 males) with 162 osteolytic vertebral fractures were treated with RFK using the StabiliT Vertebral Augmentation System (Dfine Inc, San Jose, CA). 78 patients could be followed up to 6 months.

48 patients (29 females and 19 males) with 92 vertebrae were initially treated conservatively. After 6 weeks 22 out of 48 patients and after 12 weeks 12 out of 48 patients decided to cross over to RFK. 34 out of 48 patients made a cross over to RFK. 44 patients could be followed up to 6 months.

Results: In the RFK group the median pain scores (VAS) (p< 0.001) and the Oswestry Disability Score (p< 0.001) improved significantly from pre- to post-treatment and maintained at 3 and 6 months follow up. Postoperative, 3 and 6 months follow-up RFK stabilized the vertebral height and avoided further kyphotic deformity. After 6 months 76 out of 78 patients met the criteria for clinical success.

In the conservative group only 1 out of 48 patients after the initial 6 weeks of conservative care met the criteria for clinical success and median VAS improvement was 2. After 12 weeks of conservative care, only 3 patients met the criteria for clinical success, and median VAS improvement was 2. Further the radiological data showed a significant height loss and increase in kyphotic deformity in comparison to RFK.

Conclusion: For the vast majority of patients, conservative care did not provide meaningful clinical improvement. By contrast, nearly all patients who underwent radiofrequency kyphoplasty had rapid substantial improvement. Surgery was clearly much more effective than conservative care and should be offered to patients much sooner. Further RFK did not interrupt or delay chemotherapy or radiation therapy!