Vertebral Augmentation With Kyphoplasty vs Nonsurgical Mgmt for Vertebral Body Compression Fractures

Inclusion Criteria:

* Patients with multiple myeloma (active or smoldering) with mild back pain (Visual Analog Scale \[VAS\]) ≤ 4 or no back pain (VAS=0) on a stable analgesic regimen) related to vertebral compression fractures (at least one and up to 8 index fractures from T3 to L5) as seen on magnetic resonancy imaging (MRI), computed axial tomography (CT) scan or plain radiographs.
* No major planned spine surgery for at least 6 months following enrollment.
* No evidence of epidural disease or cord compromise on magnetic resonance imaging.
* Life expectancy greater than 6 months.
* Adequate myeloma systemic control (no evidence of active progressive disease). No planned change in chemotherapy regimen for 1 month prior and for at least 1 month following enrollment. Change in dose(s) permitted.
* Adequate hematologic parameters (platelet count≥50,000/μL, and absolute neutrophil count ≥1,000). Platelet transfusions are permitted to increase platelet counts perioperatively.
* Age greater than 21 years and able to understand and sign the informed consent document.

Exclusion Criteria:

* Patients with significant comorbidities (aside from the index fracture or cancer) which would result in an unacceptable surgical risk or patients with contraindications to general or local anesthesia.
* Patients with other primary tumors including primary bone tumors or solitary plasmacytoma at site of the index VCF.
* VCF morphology deemed unsuitable for balloon kyphoplasty (vertebra planum).
* Additional non-kyphoplasty surgical treatment is required for the index fracture.
* Patients with uncontrolled pain related to the VCF (VAS\>4, or increasing opioid requirements), or with epidural disease on magnetic resonance imaging. Spinal cord compression , canal compromise and /or spinal instability requiring decompression.
* Patients with a bleeding disorder which cannot be adequately managed perioperatively.
* Patients with pain unrelated to the VCF according to the investigators.
* Patients with estimated survival less than 6 months.
* Known allergy to bone cement or all contrast media used in the treatment of study participants.
* MRI contraindication (e.g., cerebral aneurysm clips, pacemaker, implanted biostimulators, cochlear implants, penile prosthesis).