title: Kyphoplasty in patients with multiple myeloma a retrospective comparative pilot study.
abstract: BACKGROUND
  This retrospective study of 73 myeloma patients with painful vertebral lesions compares clinical and radiomorphological outcomes up to 2 years after additional kyphoplasty, radiation therapy or systemic treatment only.
  
  
  METHODS
  We assessed pain, disability and radiomorphological parameters by visual analogue scale (VAS 0-100), Oswestry Disability Index and by re-evaluating available follow-up X-rays, respectively, in patients that were treated according to a clinical pathway.
  
  
  RESULTS
  After 2 years the VAS score was reduced in all groups by 66 ± 8.2 (kyphoplasty), 35 ± 10.5 (radiation therapy) and 38 ± 20.5 (systemic therapy only). Only after kyphoplasty we observed a significantly reduced Oswestry Disability Index after 1 year (P < 0.001). Vertebral height remained stable after kyphoplasty (P = 0.283), in contrast to a progressive height loss in the other groups (P = 0.013 and P = 0.015 for radiation and systemic therapy only, respectively). Two years after kyphoplasty and radiotherapy the overall vertebral fracture incidence was significantly decreased as compared to the group after systemic therapy only (9.7% of all thoracic and lumbar vertebrae had new vertebral fractures after systemic therapy only, 2% after kyphoplasty (P < 0.001), 4.8% after radiation (P = 0.032)).
  
  
  CONCLUSIONS
  Additional kyphoplasty was more effective than additional radiation or systemic therapy in terms of pain relief, reduction of pain associated disability and reduction of fracture incidence of the entire lumbar and thoracic spine.
authors.affiliation: Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany. christian.kasperk@med.uni-heidelberg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Kasperk
authors.forename: Andreas
authors.initials: A
authors.lastname: Haas
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Kai
authors.initials: K
authors.lastname: Neben
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.forename: Ulrike
authors.initials: U
authors.lastname: Sommer
authors.forename: Peter
authors.initials: P
authors.lastname: Nawroth
authors.forename: Peter-Jürgen
authors.initials: PJ
authors.lastname: Meeder
authors.forename: Bernd
authors.initials: B
authors.lastname: Wiedenhöfer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schmidmaier
authors.forename: Michael
authors.initials: M
authors.lastname: Tanner
authors.forename: Dirk
authors.initials: D
authors.lastname: Neuhof
authors.forename: Gerd
authors.initials: G
authors.lastname: Nöldge
authors.forename: Ingo A
authors.initials: IA
authors.lastname: Grafe
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology / Q000601:surgery*; D010147:Pain Measurement; D010865:Pilot Projects; D012189:Retrospective Studies