Table 1 Indications for cement augmentation

From: The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG)

(1) Absolute indications for cement augmentation of a vertebral body or bodies due to fracture:

• Persistent significant pain from a fractured vertebral body confirmed on MRI scanning with STIR images. This fracture could be acute, sub-acute or chronic (often has a fracture cleft) and has not healed

• Persistent significant symptoms which have not resolved with normal conservative measures after 4 weeks of treatment affecting daily activities

• Significant pain due to a fractured vertebral body affecting activity

• Significant pain associated with significant change in disability in conjunction with a new event

• Acute patient-delayed for medical reasons

• Selective chronic fractures

• Complications for myeloma should be treated first and pain is not defined by a specific VAS number

• Timing is important, especially newly diagnosed patients. Immediate referral for treatment for very severe pain requiring high dose of analgesics

(2) Relative indications for cement augmentation of a vertebral body or bodies due to fracture:

• Fracture of the thoracolumbar junction (T10–L2) that could result in a significant kyphotic deformity and therefore morbidity

• Loss of vertebral body height (progressive as evidenced by sequential erect x-rays)

• Posterior wall defect or destruction of a pedicle/pars which may potentially render the affected area of the spine unstable and at risk of fracture/neurological insult new tumour classification system to delineate vertebral bodies at risk of impending fracture as a result of metastatic spinal disease82,83. May be used for classification for myeloma patients as well but this needs to be myeloma spinal disease validated

(3) Conditional or prophylactic indications for cement augmentation of a vertebral body or bodies due to fracture:

(A) Loss of vertebral height sufficient to affect functional activities

• Fracture at T10–L2 (thoraco-lumbar junction) consider cement augmentation; below L2 is not as significant

• Only if progression over time; follow up with standard x-rays every 1–3 months

(B) Risk of impending fracture

• Need to take into consideration the aggressive nature of the disease and patient activity

• “Impending fractures” hard to determine

• Need for clinical trials

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