Understanding
Balloon Kyphoplasty
and
Myeloma-Induced
Vertebral Compression
Fractures
International Myeloma Foundation
12650 Riverside Drive, Suite 206
North Hol ywood, CA 91607 USA
Telephone:
800-452-CURE (2873)
(USA & Canada)
818-487-7455
Fax: 818-487-7454
TheIMF@myeloma.org
www.myeloma.org
6/06
Table of Contents
Introduction
5
What Are Vertebral Compression Fractures? 6
Treatment Options for VCFs
7
Bal oon Kyphoplasty
9
How the Bal oon Works
10
Who Can Benefit From Bal oon Kyphoplasty? 12
How Long Does the Procedure Take?
12
How Long is the Recovery Period?
12
Are There Risks Associated
with Bal oon Kyphoplasty?
12
Does Bal oon Kyphoplasty Relieve Pain?
13
Is Bal oon Kyphoplasty Compatible
with Other Therapies?
14
Does Insurance Cover Bal oon Kyphoplasty? 14
Questions to Ask Your Doctor
14
About the IMF
15
Glossary
18
Sponsored by an unrestricted educational grant from Kyphon Inc.
©2006, International Myeloma Foundation, North Hollywood, California
Introduction
Myeloma is a cancer that af ects the plasma
cel s of the bone marrow. This rare and com-
plex disease replaces
healthy bone marrow
with malignant plasma
cel s (myeloma cel s),
often causing wide-
spread development
of lesions and destruc-
tion of bone. Myeloma
also prevents the bone
marrow from forming cel s
that are important to the
immune system, leaving
patients vulnerable to infec-
tion and disease.
Lesions occur most com-
monly in the bones of
the spinal column. Most
myeloma patients expe-
rience pain, especial y
in the back and the
ribs. More often than
not, back pain and
generalized weakness
are what bring many
undiagnosed myeloma
patients to the doctor in
the first place.
Sudden severe back pain can
indicate that the vertebral body
*Words appearing in bold are defined in the glossary at
the back of the booklet.
4
5
of a vertebra has fractured or col apsed.
Fractures of the bones of the spinal column
are cal ed vertebral compression fractures
(VCFs) or simply, spinal fractures.
Treatments to al eviate the pain associat-
ed with VCFs range from over-the-counter
medications to major open spine surgery.
Minimal y invasive surgical techniques,
Normal Vertebra
Fractured Vertebra
as myeloma. In myeloma patients, moderate
like bal oon kyphoplasty, fal in the middle
to severe back pain is usual y caused by
of these treatment options. This brochure
VCFs. Approximately 70% of patients with
explains why VCFs occur and presents a
myeloma and back pain already have one
number of treatment options. In addition, it
or more VCFs at the time of diagnosis. There
provides a step-by-step explanation of bal-
are several known facts about how myeloma
loon kyphoplasty.
af ects bone and contributes to VCFs.
Although it is not yet possible to cure myelo-
Bone is living tissue that is maintained by
ma, it is possible to improve the quality of
a delicate interplay between the cel s that
life for patients. With this booklet, you wil
form new bone (osteoblasts) and the cel s
be bet er able to discuss your condition with
that remove old bone (osteoclasts). Myeloma
your physician and formulate a treatment
cel s do not directly af ect bone; however,
plan that's best for you.
they indirectly destroy bone by signaling
What are Vertebral Compression
the osteoclasts to resorb (break down) bone
FraCtures?
uncontrol ably. The malignant cel s spread
Vertebral compression fractures are frac-
throughout the skeletal system, causing bone
tures of the bones of the spinal column. A
loss that mimics osteoporosis.
VCF occurs when the vertebra fractures or
n Because so much bone is lost, high levels
col apses because the bone is too weak to
of calcium are released into the blood-
withstand the pressure or stress placed upon
stream. This condition is cal ed hypercal-
it. With multiple fractures, the spine shortens
cemia, and is common in patients with
and becomes misaligned, causing a "hunch-
myeloma. Hypercalcemia increases bone
backed" condition known as kyphosis.
destruction and frequently impairs kidney
Vertebral compression fractures are usual y
function.
caused by osteoporosis, but they can also be
n In patients with myeloma, excessive osteo-
caused by diseases that af ect the bone, such
clast activity suppresses the formation of
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7
osteoblasts, the cel s that create bone. This
activity. Bisphosphonate therapy is consid-
imbalance between bone-destroying and
ered standard treatment for patients with
bone-creating cel s further weakens the
cancer-induced hypercalcemia and myelo-
skeleton.
ma-related bone lesions. Treatment with
bisphosphonates significantly reduces bone
treatment options For VCFs
pain in at least 50% of patients and can
analgesics
reduce the frequency of VCFs by 25%45%.
Analgesics are drugs that relieve pain and
Bisphosphonate therapy also lessens the
include nonsteroidal anti-inflammatory
need for bone radiation.
agents (NSAIDs), such as aspirin, and con-
Vertebroplasty
trol ed substances available only by prescrip-
Vertebroplasty is a minimal y invasive sur-
tion. NSAIDs are useful for the al eviation of
gical procedure in which bone cement is
mild pain. Due to a risk of gastrointestinal,
injected directly into the col apsed vertebra.
liver, and kidney toxicity, patients taking
The purpose of this procedure is to stabilize
NSAIDs must be closely monitored. For severe
the fracture and reduce pain. Patients receive
pain, stronger analgesics, such as narcotics,
either general or local anesthesia. Guided
can be used. Treatment with analgesics wil
by an imaging device, the physician uses a
neither prevent additional VCFs nor repair
syringe to inject bone cement into the frac-
the fractures.
ture. Patients remain in bed for a minimum of
radiation
one hour afterward, to al ow the cement to
Radiation therapy provides pain relief in
harden. Patients having vertebroplasty may
myeloma patients with VCFs by destroying
require an overnight stay in the hospital.
the ability of the myeloma cel s to grow and
Vertebroplasty stabilizes the fracture; howev-
divide. Radiation may be used alone, or
er, cement leakage outside the vertebra has
as part of the patient's treatment regimen.
been sited as a common occurrence. For most
Pain relief is usual y achieved several days
patients, cement leakage has no noticeable
after therapy. Analgesics may be used with
ef ect, but there have been occasional reports
radiation therapy to al eviate pain until the
of significant complications involving cement
radiation has an ef ect. Radiation does not
leakage fol owing vertebroplasty. Some stud-
repair the fracture.
ies suggest vertebral body height restoration
bisphosphonates
has been noted with vertebroplasty.
Bisphosphonates are drugs that bind to the
surface of bone, inhibiting bone breakdown
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9
balloon kyphoplasty
ies also cite significant improvement in qual-
Bal oon kyphoplasty is a medical procedure
ity of life and mobility.
that is similar to vertebroplasty in several
hoW the balloon Works
ways. Like vertebroplasty, bal oon kypho-
Bal oon kyphoplasty is a minimal y invasive
plasty is a minimal y invasive procedure that
procedure in which orthopedic bal oons are
uses bone cement to stabilize the fracture,
used to gently elevate the fractured vertebra,
which in turn, reduces bone pain and helps
in an at empt to return it to the correct posi-
increase the patient's overal quality of life.
tion. Before the procedure, you wil have
Unlike vertebroplasty, bal oon kyphoplasty
diagnostic studies, such as x-rays and mag-
uses orthopedic bal oons in an at empt to
netic resonance imaging (MRI), to determine
correct the vertebral deformity, restore the
the exact location and configuration of the
height of the col apsed vertebra, and create
fracture.
a void before bone cement is deposited.
After the void has been created, the bal oon
Bal oon kyphoplasty can be done under
is deflated and removed, and then bone
local or general anesthesia your doctor wil
cement is used to fil the void. Though some
decide which option is appropriate for you.
cement leakage has been reported, this con-
Typical y, the procedure takes less than one
trol ed fil ing reduces the risk of cement leak-
hour per fracture treated and may require an
age. It has been reported that in both cancer
overnight hospital stay. Bal oon kyphoplasty
and osteoporosis patients treated with bal-
begins with two smal incisions, approxi-
loon kyphoplasty, cement leakage is lower
mately 1 cm in length. Using a hol ow instru-
than in patients treated with vertebroplasty.
ment, the surgeon creates a smal pathway
into the fractured bone. A smal , orthopedic
In a prospective evaluation (Khanna et
bal oon is guided through the instrument into
al, Osteoporosis International, 2006
the vertebra. Next, the bal oon is careful y
17:817-826), 56 patients with myeloma-
inflated in an at empt to raise the col apsed
induced VCFs that were treated with bal oon
vertebra and return it to its normal position.
kyphoplasty at Cleveland Clinic were evalu-
ated at a median time of 12.8 months after
the procedure. Improvements in 7 of 8 qual-
ity of life categories were not only noted, but
were found to be significant. The 7 catego-
ries that demonstrated marked improvement
were: social functioning, mental component,
physical component, physical function, physi-
cal role, vitality, and bodily pain. Other stud-
Bal oon placement
Ful inflation
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Because the procedure uses a bal oon to
correct the compressed vertebra before
injecting cement, patients can also expect
restoration of some of the vertebral body
height they may have lost as a result of
the fracture. Patients treated with bal oon
kyphoplasty can regain more than one-third
Void within
Fil ing the cavity
of the vertebral body height lost due to
vertebral body
with bone cement
fracture. This amount may vary from patient
to patient.
hoW long Does the proCeDure take?
On average, bal oon kyphoplasty takes
less than an hour for each vertebra treated.
Usual y, the bal oons are inserted on both
sides of the vertebra.
The internal cast
hoW long is the reCoVery perioD?
Once the vertebra is in the correct position,
Most patients who have bal oon kyphoplasty
the bal oon is deflated and removed. This
are discharged from the hospital the fol ow-
process creates a void (cavity) within the
ing day. Patients can typical y resume day-to-
vertebral body. The cavity is fil ed with bone
day activities the day after the procedure.
cement to support the surrounding bone and
prevent further col apse. The cement forms
are there risks assoCiateD With balloon
an internal cast that holds the vertebra in
kyphoplasty?
place. General y, the procedure is done on
Any type of surgery involves risk. Although
both sides of the af ected vertebra.
the complication rate for bal oon kypho-
Who Can beneFit From balloon
plasty is low, serious adverse events, some
of which can be fatal, can occur, including
kyphoplasty?
myocardial infarction (heart at ack), cerebro-
Bal oon kyphoplasty is suitable for myeloma
vascular accident (stroke), pulmonary embo-
patients with adequate white blood cel
lism (blood, fat or cement clot that migrates
counts and normal coagulation studies. Most
to the lungs), and cardiac arrest (heart stops
VCFs can be treated with bal oon kypho-
beating).
plasty; however, you wil need to consult
with your doctor to determine if you are a
Other risks (relevant to the anatomy being
candidate for the procedure.
treated) include deep or superficial wound
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infection, leakage of bone cement into the
Does insuranCe CoVer balloon
muscle and tissue surrounding the spinal
kyphoplasty?
cord, and nerve injury that can, in rare
For patients with Medicare coverage, bal-
instances, cause paralysis. Patients are
loon kyphoplasty is a covered benefit when
encouraged to discuss these and other risks
the procedure is determined to be medical y
with their physician.
necessary. For patients with private insur-
Patients with unstable VCFs (due to destruc-
ance, coverage varies, depending on the
tion of the vertebral body), compression of
insurance company and the type of cover-
the nerves around the spinal cord, persistent
age. Questions about coverage should be
abnormal coagulation, local infection at the
directed to the insurance provider.
intended injection site, or those who cannot
Questions to ask your DoCtor
tolerate being prone are not considered
If you are considering bal oon kyphoplasty,
good candidates for the procedure. Patients
you may have questions for your doctor. You
are encouraged to consult with their doctor
may want to ask the fol owing:
to determine if they are candidates for the
procedure.
n Am I a candidate for bal oon
kyphoplasty?
Does balloon kyphoplasty relieVe pain?
n Where wil this procedure be done?
Many patients treated with bal oon kypho-
plasty report an almost immediate decrease
n How much experience do you have in
in pain, varying from partial to complete
performing bal oon kyphoplasty?
pain relief. For many patients, if not most,
n Should I receive general or local
pain relief is sustained in the long term.
anesthesia?
is balloon kyphoplasty Compatible With
n How long wil the procedure take in my
other therapies?
case?
Yes. Bal oon kyphoplasty wil not interfere
n Wil this interfere with any other treatment
with chemotherapy or radiation treatment.
I'm receiving?
In addition, analgesics may stil be taken
n What are possible complications that I
for pain and bisphosphonates may be
should be aware of?
continued.
n How long wil I be in the hospital?
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15
About the IMF
The IMF provides programs and services to
aid in the research, diagnosis, treatment,
"One person can make a dif erence,
and management of myeloma. The IMF
Two can make a miracle."
ensures that no one must brave the myeloma
Brian D. Novis
bat le alone.
IMF Founder
We care for patients today, while working
Myeloma is a lit le-known, complex, and
toward tomorrow's cure.
often misdiagnosed bone marrow cancer
How Can the IMF Help You?
that at acks and destroys bone. Myeloma
af ects approximately 75,000 to 100,000
patient eDuCation
people in the United States, with more than
inFormation paCkage
15,000 new cases diagnosed each year.
Our free IMF InfoPack provides comprehensive
While there is presently no known cure for
information about myeloma, treatment options,
myeloma, doctors have many approaches
disease management, and IMF services. It
to help myeloma patients live bet er and
includes our acclaimed Patient Handbook.
longer.
internet aCCess
The International Myeloma Foundation (IMF)
Log on to www.myeloma.org for 24-hour
was founded in 1990 by Brian and Susie
access to information about myeloma, the IMF,
education, and support programs.
Novis shortly after Brian's myeloma diagno-
sis at the age of 33. It was Brian's dream that
online myeloma Forum
future patients would have easy access to
Join the IMF Internet Discussion Group at
medical information and emotional support
www.myeloma.org/listserve.html to share your
throughout their bat le with myeloma. He
thoughts and experiences.
established the IMF with the 3 goals of treat-
myeloma minute
ment, education, and research. He sought
Subscribe to this free weekly email news-
to provide a broad spectrum of services for
let er for up-to-the-minute information about
patients, their families, friends, and health
myeloma.
care providers. Although Brian died 4 years
patient & Family seminars
after his initial diagnosis, his dream didn't.
Meet with leading experts in myeloma treat-
Today the IMF reaches out to an international
ment to learn more about recent advances in
membership of more than 125,000. The IMF
therapy and research.
was the first organization dedicated solely to
myeloma matriX
myeloma, and today it remains the largest.
On our website and in print, this document is a
comprehensive guide to drugs in development
for myeloma.
16
17
myeloma toDay neWsletter
Glossary
Our quarterly newslet er is available free of
charge by subscription.
Analgesic: A drug that relieves pain, including over-the-
counter medications such as aspirin or acetaminophen,
support
and prescription medication such as morphine and other
myeloma hotline: 800-452-Cure (2873)
opiates.
Toll-free throughout the United States and
Bisphosphonate: A smal inorganic molecule that binds to
Canada, the IMF Hotline is staf ed by trained
the surface of damaged bone. Bisphosphonates are given
information specialists and is in frequent inter-
to patients with bone disease to inhibit the breakdown
action with members of our Scientific Advisory
of bone.
Board.
Bone marrow: The soft, spongy center of the bone. White
blood cel s, red blood cel s, and platelets are formed in
support groups
the marrow.
A worldwide network of more than 100 myelo-
Chemotherapy: A class of drugs used to destroy cancer
ma support groups hold regular meetings for
cel s.
members of the myeloma community. The IMF
Coagulation: The process of a liquid changing into a thick-
conducts annual retreats for myeloma support
ened mass, e.g., blood forming into a clot.
group leaders.
Hypercalcemia: Higher than normal levels of calcium in
the blood.
researCh
Kyphosis: An exaggeration of the normal curve of the
bank on a Cure®
spine, often referred to as a "hunchback" or "dowager's
This DNA bank wil provide genetic data
hump."
research in new drug development.
Lesion: Any abnormality involving any tissue or organ,
due to disease or injury.
the international staging system (iss)
Myeloma: A cancer of the plasma cel s found in bone mar-
This updated staging system for myeloma wil
row. Cancerous plasma cel s are cal ed myeloma cel s.
enhance physicians' ability to select the most
Nonsteroidal anti-inflammatory drug (NSAID): A drug, such
appropriate treatment for each patient.
as ibuprofen or acetaminophen, used to reduce fever,
swel ing, pain, and redness.
researCh grants
Osteoblast: A cel that forms bone tissue; a bone-growing
Leading the world in col aborative research
cel .
and achieving extraordinary results, the IMF
Osteoclast: A cel that resorbs or breaks down bone.
Grant Program supports both junior and senior
Osteoporosis: A disease that causes weak or porous
researchers working on a broad spectrum of
bones.
projects. The IMF has at racted many young
Vertebra: Any one of the 33 bony segments of the spinal
investigators into the field of myeloma, and
column.
they have remained in the field and are actively
Vertebral Body: The round bony area of a vertebra.
pursuing a cure for this disease.
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