Treatment of Malignant Vertebral Fractures With Percutaneous Balloon Kyphoplasty. (KYPHOK)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00748631
Recruitment Status : Terminated (the data collected are enough to obtain a qualitative analysis.)
First Posted : September 8, 2008
Last Update Posted : March 24, 2015
Information provided by (Responsible Party):
Assistance Publique - Hôpitaux de Paris

Brief Summary:

Balloon Kyphoplasty is an alternative to vertebroplasty in the treatment of painful malignant vertebral fractures. This is a mini-invasive percutaneous treatment, aiming to stabilize the vertebral fracture, decrease of pain. This technique also improves patient function. Namely, bedridden patients are often able to resume walking in the days following vertebral cement injection. Advantage of Balloon Kyphoplasty as compared to vertebroplasty is the ability to inject the cement into the diseased vertebral body which shows cortical destruction with lower pressure, thereby possibly reducing cement leakage and related complications.

This is a multicentric, observational prospective study. Patients are evaluated before and after the procedure.

Sixty women or men older than 18 years, with 1 to 3 painful vertebral fracture(s) of malignant origin (due to multiple myeloma or osteolytic vertebral metastasis) will be enrolled. Each patient will be followed during 1 year after the procedure with 7 visits at D-8, D-1, D1, D15, D90, D180, and D360 or until the death of the patient.

The main evaluation outcome is patient self-global satisfaction regarding the procedure on a semi-quantitative satisfaction scale, 15 days after the Balloon Kyphoplasty.

Condition or disease Intervention/treatment Phase
Vertebral Fracture Multiple Myeloma Osteolytic Metastases Device: balloon kyphoplasty Not Applicable

Detailed Description:

Vertebral compression fractures (VCF) represent an important source of morbidity in patients presenting osteolytic metastatic or myelomatous vertebral involvement. In addition, cancer treatments may induce osteoporosis with an additional risk of vertebral fractures.

  • Current medical treatments are symptomatic. They do not treat the fracture itself.
  • Vertebroplasty is an interventional radiological technique that consists of injecting, percutaneously, acrylic cement into the fractured vertebra under radiological guidance and local or general anaesthesia, in order to combine two effects: stabilization of the vertebral body fracture and pain reduction.
  • Balloon Kyphoplasty is a variant of vertebroplasty which is performed using the KyphX® System (Medtronic., Sunnyvale, California). Balloon kyphoplasty aims at restore vertebral height of the fractured vertebra using an inflatable balloon prior to inject surgical polymethylmetacrylate (PMMA)cement,into the vertebral body to fix the fracture. It is an expensive technique costing around 4,000 euros for up to 2 vertebrae in the same patient. The surgical technique for the procedure has been described by LIBERMEAN et al: A bilateral approach is usually chosen to insert working cannulas into the posterior part of the vertebral body through a posterior transpedicular approach. In case of limited and asymmetric vertebral destruction, a single unilateral approach may be preferred. Fluoroscopy is used to insert the tools and control the procedure. With reaming tools, two working channels are created and the balloons are inserted. The balloons are available in lengths of 10, 15 and 20 mm.

The two balloons (one on each side) should ideally be centered at middle height between the superior and inferior endplates and in the anterior two-thirds of the vertebral body. Balloon placement into the vertebral body is checked using radiopaque markers at the two extremities of the balloon. Once inserted, the balloons are inflated using visual, volume and pressure control to create a cavity. Inflation is stopped when one of the following inflation endpoints is reached: pressure raised over 400 psi, balloon contacts one of the cortical bone of the vertebra or reaching maximal balloon inflation volume. The balloons are then deflated and removed. The mean balloon inflation volume is 2 to 3ml. The Bone Filler Device, filled before with 1.5 ml of PMMA, is then advanced through the working cannula towards the anterior part of the cavity and cement is slowly extruded by a stainless steel stylet, acting as a plunger. When the amount of cement from the first Bone Filler Device is delivered in the cavity, it is removed and another Bone Filler Device is advanced through the working cannula. This step is repeated till a complete fill of the cavity is obtained. The same procedure is repeated through the other working cannula at the contra-lateral pedicle. Filling of the cavity with highly viscous PMMA is performed under continuous fluoroscopic control.

The aim of this study is to quantify the analgesic and patient function improvement of Balloon Kyphoplasty together with complication types and rate in patients with malignant vertebral fractures due to metastatic disease or multiple myeloma.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 60 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Assessment of Percutaneous Balloon Kyphoplasty in the Treatment of Malignant Vertebral Fractures (Multiple Myeloma and Osteolytic Metastases) : "Observational Study"
Study Start Date : October 2007
Actual Primary Completion Date : November 2009
Actual Study Completion Date : November 2010

Arm Intervention/treatment
Experimental: 1
balloon Kyphoplasty
Device: balloon kyphoplasty
A bilateral approach is chosen to insert working cannulas into the posterior part of the vertebral body through a posterior transpedicular approach.Once inserted, the balloons are inflated using visual, volume and pressure control to create a cavity.The balloons are then deflated and removed. The Bone Filler Device is then advanced through the working cannula towards the anterior part of the cavity and cement is slowly extruded by a stainless steel stylet, acting as a plunger. When the amount of cement from the first Bone Filler Device is delivered in the cavity, it is removed and another Bone Filler Device is advanced through the working cannula.

Primary Outcome Measures :
  1. Percentage of patients having a residual pain of ≤ 35mm on a VAS scale or a 50 % decrease in daily morphine dose at day 15 after Balloon Kyphoplasty compared to day 0 (day of procedure). [ Time Frame: day 15 ]

Secondary Outcome Measures :
  1. 1° Clinical Outcomes:· Pain evaluation using a visual analogic scale [ Time Frame: D-8-D-1, D2 to D5, d15, D90, D180; D360 ]
  2. quality of life evaluation (SF 12). [ Time Frame: D-8 to D-1, D2 to D5, D15, D90, D180; D360 ]
  3. Assessment of the pain due to the compression fracture using a VAS scale in the same position as at the inclusion visit (standing or lying down), [ Time Frame: D-8 to D-1, D2 to D5, D15, D90, D180; D360 ]
  4. Assessment of the patient global satisfaction score using a LICKERT Scale, [ Time Frame: D-8 to D-1, D2 to D5, D15, D90, D180; D360 ]
  5. Percentage of patients who estimate than the pain due to the compression has decreased by more than 50% after the procedure, [ Time Frame: day 15 ]
  6. · Percentage of patients who give a positive answer to the following question: "would you agree to undergo a new Balloon Kyphoplasty in case you need it?" [ Time Frame: D2 to D5, D15; D90 ; D180; D360 ]
  7. Time elapsed between Balloon Kyphoplasty procedure and patient get up. [ Time Frame: D2 to D5; D15;D90 ]
  8. Resumption of the upright position for patients confined to bed due to their vertebral fracture [ Time Frame: D2 to D5; D15 ]
  9. Local and general complications related to cement leakage at each vertebral level treated. [ Time Frame: each visit ]
  10. 2° Radiological Outcomes: · Modification of the regional kyphosis angle measured by the Traumatic Regional Angle (ART - STAGNARA and NIEDERMANN) for compression fractures of T10 to L5 [ Time Frame: D2to dJ5-d15-d90.-d180- d360 ]
  11. Modification of the global Thoracic and lumbar kyphosis angles. [ Time Frame: D2 to d5 - D15 - D90 - d180 - d360 ]
  12. 3° Therapeutic Outcomes :· Need for radiation at day 30 after Balloon Kyphoplasty in patient presenting with Multiple Myeloma. [ Time Frame: D30 ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Male or female, 18 years or older
  2. 1 to 3 vertebral compression fracture(s), between T5-L5, responding to the following criteria:

    • at least 15% loss of vertebral body height (anterior, median or posterior);
    • malignant origin (bone metastases, multiple myeloma, hemopathy) assessed by imaging, including an MRI and a CT-SCAN of less than 4 weeks.
    • Pain or painful deterioration less than 3 months old, related to one or more vertebral fractures with a VAS higher than 50/100 mm when changing position, or higher than 40/100 mm if associated with morphine ≥ 30 mg/day ;
  3. The pain related to the fractured vertebrae is the more prevalent
  4. More than 3 months life expectancy.
  5. Blood Platelets rate more than or equal to 50 000/mm3 within the week before balloon kyphoplasty procedure (after a correct blood transfusion).
  6. Patient must have signed a consent form.
  7. Patient affiliated to social security

Exclusion Criteria:

  1. Patient younger than 18
  2. Impossibility to perform Balloon Kyphoplasty:

    • Technical impossibility to achieve the percutaneous approach to the vertebra to treat.
    • Vertebral pedicle diameter or height of treated vertebra(e) not sufficient regarding balloon kyphoplasty TROCATHETER size. This should be assessed through prescreening MRI and/or CT-Scan
  3. More than three symptomatic vertebral compression fractures in the same vertebral segment.
  4. Patient receiving additional local treatment within 15 days after balloon kyphoplasty procedure (surgery, radiofrequency, radiotherapy).
  5. Patient with primary bone tumors (eg : osteosarcoma) or single solitary plasmocytoma (patients presenting those tumors on other parts of the body, other than VCF are eligible).
  6. Patients presenting sclerotic or mixed vertebral lesions(sclerotic vertebral lesions at another vertebral level are not a contraindication).
  7. Patients with less than 3 month life expectancy
  8. Patient undergoing an experimental anti-cancerous treatment in Phase I evaluated at the same time
  9. Patient having relevant co-morbidities which may interfere with the data management on pain and quality of life.
  10. Patient presenting an inadequate vertebra with Balloon Kyphoplasty.
  11. Patient undergoing an additional treatment other than balloon kyphoplasty for their vertebral fracture.
  12. Patient presenting neurological signs or spinal cord compression or spinal canal narrowing requiring surgical decompression;
  13. Patient with a medical or surgical condition not compatible with balloon kyphoplasty procedure (eg : a non-treated local infection)
  14. Patient having an allergy to the bone cement and/or to the contrast media used during the balloon kyphoplasty procedure.
  15. Pregnant or breast feeding women

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00748631

Hôpital Henri Mondor - Service de Radiologie
Creteil, Val de Marne, France, 94000
Hôpital Lariboisière-service de radiologie ostéoarticulaire
Paris, France, 75010
Hôpital Cochin - service de radiologie
Paris, France, 75014
Hopital Bichat -service de radiologie
Paris, France, 75018
Sponsors and Collaborators
Assistance Publique - Hôpitaux de Paris
Study Director: Jean-Denis LAREDO, M.D.,PR. Assistance Publique - Hôpitaux de Paris
Principal Investigator: Antoine FEYDY, M.D., PhD Assistance Publique - Hôpitaux de Paris

Responsible Party: Assistance Publique - Hôpitaux de Paris Identifier: NCT00748631     History of Changes
Other Study ID Numbers: P050323
First Posted: September 8, 2008    Key Record Dates
Last Update Posted: March 24, 2015
Last Verified: November 2014

Keywords provided by Assistance Publique - Hôpitaux de Paris:
Vertebral fracture
Vertebral compression fracture
Multiple Myeloma Bone marrow diseases
Vertebral metastases
Balloon Kyphoplasty

Additional relevant MeSH terms:
Multiple Myeloma
Neoplasms, Plasma Cell
Fractures, Bone
Neoplasm Metastasis
Spinal Fractures
Neoplasms by Histologic Type
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases
Wounds and Injuries
Neoplastic Processes
Pathologic Processes
Spinal Injuries
Back Injuries