Radiation

External beam radiation therapy is used in the majority of patients with fractures and isolated plasmacy-tomas. It can be useful for urgent pain control and relief of neurologic compromise. The typical dose is 30 Gy delivered in 10 fractions; however no standard dose is defined.

SURGICAL INTERVENTIONS Vertebroplasty

Vertebroplasty has been used to relieve pain in patients with pathologic vertebral or osteoporotic compression fractures.60 It is accomplished by the injection of low-viscosity bone cement into a damaged vertebral body.61 Two drawbacks to the procedure have been suggested: the technique is not able to restore normal structure of the spine, and cement leakage may occur.60

Kyphoplasty

Kyphoplasty is another surgical technique designed to restore height to collapsed vertebral bodies in order to decrease pain and improve function and mobility. The method involves the insertion of a deflated balloon into the potential space between the upper and lower end-plates of the collapsed vertebrae and inflating the balloon to push the vertebral end-plates apart, thus restoring height. The expanded cavity is then filled with a viscous, partially cured cement, thus supporting the expanded endplates and minimizing the potential for leak.60 A prospective cohort study of 55 kypho-plasty procedures in 18 MM patients with osteolytic vertebral compression fractures demonstrated an average gain of 34% of lost height with no major procedure-related complications.60 Patients also experienced a significant improvement in objective scores of bodily pain, physical function, vitality, and social function.60 Importantly, patients in this study had a mean duration of symptoms prior to procedure of 11 months (range 0.5-24 months), suggesting that patients with "old" fractures should be evaluated by an orthopedic surgeon skilled in this technique to assess potential benefit.

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