A 65-year-old man with known multiple myeloma presents with sudden onset severe back pain. Whole-spine MRI shows multiple vertebral lesions with a fresh T10 compression fracture causing moderate canal compromise but no neurological deficit. Bone biopsy of an accessible lesion confirms plasma cell myeloma. The most appropriate intervention for the T10 vertebral fracture is:

• A Conservative management with back brace and analgesics pending systemic treatment
• B Surgical decompression and posterior stabilization urgently
• C Vertebroplasty or kyphoplasty for pain relief and vertebral stabilization ✓
• D High-dose radiotherapy alone to the T10 level

Explanation

For myeloma-related vertebral compression fractures causing pain without neurological deficit, balloon kyphoplasty (preferred over vertebroplasty as it restores vertebral height and has lower cement leakage rate) provides rapid pain relief, structural stabilization, and allows continuation of systemic therapy without delay. Vertebroplasty/kyphoplasty is now recommended for painful, non-neurologically compromised myeloma vertebral fractures. Surgical decompression/stabilization is reserved for fractures causing or imminently threatening spinal cord compression or fractures with significant instability. Conservative management is inadequate for active fracture-related pain. Radiotherapy alone does not address structural vertebral collapse.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.