Table 2 Immediate vertebral 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)

Acute VCF with severe pain VAS ≥ 6

• However, often patients can be temporally stabilised in thermostatic TLSO (thoracolumbar sacro orthosis) to adequately control their pain while medical management is initiated

• Following 1–2 cycles of chemotherapy if patients present with poor performance status, septic, or have hyperviscosity problems that can be contraindications to undergo the procedure. Patients can be still treated with cement augmentation if still clinically indicated. The analgesics, bisphosphonate and chemotherapy treatment can provide pain relief and may alleviate some of the fracture pain.

Subacute VAS 4–6

• Patients with VCFs that are borderline should be treated with chemotherapy, bisphosphonates and conventional pain relief measures and if these fail then cement augmentation should be considered. If the pain persists or worsens or there is a risk for further vertebral collapse, then early intervention is required if stabilising the spinal structure and/or restoring the vertebral body height are critical.

• If the pain persists at the site of a previously diagnosed fracture the cement augmentation is still indicated if the pain is thought to be fracture and not facet joint related pain. These patients often have a fracture cleft in the vertebral body on the MRI imaging.

• VAS 1–3 Watchful surveillance with periodic skeletal survey (or other imaging as appropriate)

  1. VAS visual analogue pain scores, VCF vertebral compression fractures
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