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988 - Rapid Relief: Kyphoplasty as Early Intervention for Vertebral Compression Fracture in Cancer-Related Opioid-Dependent Pain

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

ZT

Zachary Tenner, BA

Medical Student
New York University Grossman Long Island School of Medicine
Mineola, New York, United States

Co-Author(s)

EJ

Eric Jones, MD

Resident Physician
Icahn School of Medicine at Mount Sinai
Mineola, New York, United States
TA

Tariq AlFarra, DO

Assistant Professor
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Case Diagnosis: During pre-surgical workup for a patient with metastatic cancer and osteopenia, MRI revealed an L2 superior endplate fracture. The patient had nonradiating, midline spinal pain that intensified with activity, limiting her ability to perform activities of daily living. To manage her pain without escalating opioids, L2 kyphoplasty was performed, providing complete pain relief two weeks before her scheduled tumor debulking.

Case Description: A 78-year old female with history of ovarian cancer and osteopenia presented with persistent low back pain for ~1 month, described as dull and occasionally sharp, without a trigger. Pain worsened with walking, standing, and severely hindered her sleep at night. Conservative treatments, including heating pads, gabapentin, tylenol and physical therapy, provided minimal relief. Examination demonstrated pain with lumbar extension and positive for tenderness to palpation diffusely across lower back. Subsequent imaging showed a subacute L2 compression fracture, leading to a halt in physical therapy and addition of tramadol for pain management. Due to worsening symptoms, limited opioid response, and upcoming oncologic intervention, kyphoplasty was selected to offer rapid pain control.

Discussions: The treatment plan for compression fractures depends on patient-specific circumstances. As first-line treatments can include conversative rest, analgesic medication, and bracing, surgical intervention can be overlooked. As a palliative treatment for cancer-related compression fractures, kyphoplasty has been cited to improve pain from 7.05 to 2.96 on a 10-point pain scale in less than four weeks. For cancer patients already dependent on opioids, early kyphoplasty can optimize pain management and functional recovery.

Conclusions:
Vertebral compression fracture surgical treatment can often be delayed due to conservative first-line treatments; however, in patients with opioid tolerance and complex medical needs, early kyphoplasty should be considered. This case highlights kyphoplasty’s value in rapidly restoring function and relieving pain, making it a valuable early option in cancer patients with compression fractures.