Efficacy of radiofrequency ablation and kyphoplasty for the palliation of pain related to multiple myeloma

Purpose: To evaluate the effectiveness of radiofrequency (RF) ablation and kyphoplasty for the palliation of painful axial skeletal lesions due to multiple myeloma.

Materials and Methods: This is a single center, Institutional Review Board-approved retrospective review of patients who underwent kyphoplasty and RF ablation for painful malignant lesions in the axial skeleton due to multiple myeloma between January 2017 and June 2022. Review parameters included technical and clinical data up to the last follow-up visit at intervals 0-2 days, 3-7 days, 8-28 days, 29-100 days, 101-200 days, and 201-400 days post procedure. Data included demographics, baseline pain score and post-procedural pain score using the Numerical Rating Scale (NRS), and pre- and post-procedural oral morphine equivalent dose (OMED). Procedure-related adverse events (AEs) were collected.

Results: One hundred and two patients were treated for 163 lesions of the thoracolumbar spine and one pelvic lesion due to multiple myeloma. All ablations were technically successful, and all were followed by kyphoplasty or cementoplasty. Subjects experienced significant improvement in average pain for all intervals (P < .0001) and significant decrease in average opioid usage for all intervals (P < .0001). Mean worst NRS pain score decreased from 7.4±2 at baseline to 2.4±2.4 at 0-2 days post procedure and 2.2±2.2 at 201-400 days post procedure. Mean OMED decreased from 208±161.7 mg at baseline to 34.4±48 mg at 0-2 days post procedure and 52.8±74.4 mg at 201-400 days post procedure.  No immediate adverse events related to the procedure were identified.

Conclusion: RF ablation followed by kyphoplasty is an effective palliative treatment option for patients with painful axial skeletal lesions due to multiple myeloma, as demonstrated by significant post-procedural pain improvement within 2 days with sustained long-term relief through 400 days.