• 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 ] [ Designated as safety issue: Yes ]
  

• 1° Clinical Outcomes:· Pain evaluation using a visual analogic scale [ Time Frame: D-8-D-1, D2 to D5, d15, D90, D180; D360 ] [ Designated as safety issue: Yes ]
  
• quality of life evaluation (SF 12). [ Time Frame: D-8 to D-1, D2 to D5, D15, D90, D180; D360 ] [ Designated as safety issue: No ]
  
• 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 ] [ Designated as safety issue: Yes ]
  
• 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 ] [ Designated as safety issue: No ]
  
• 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 ] [ Designated as safety issue: No ]
  
• · 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 ] [ Designated as safety issue: No ]
  
• Time elapsed between Balloon Kyphoplasty procedure and patient get up. [ Time Frame: D2 to D5; D15;D90 ] [ Designated as safety issue: No ]
  
• Resumption of the upright position for patients confined to bed due to their vertebral fracture [ Time Frame: D2 to D5; D15 ] [ Designated as safety issue: No ]
  
• Local and general complications related to cement leakage at each vertebral level treated. [ Time Frame: each visit ] [ Designated as safety issue: Yes ]
  
• 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 ] [ Designated as safety issue: No ]
  
• Modification of the global Thoracic and lumbar kyphosis angles. [ Time Frame: D2 to d5 - D15 - D90 - d180 - d360 ] [ Designated as safety issue: No ]
  
• 3° Therapeutic Outcomes :· Need for radiation at day 30 after Balloon Kyphoplasty in patient presenting with Multiple Myeloma. [ Time Frame: D30 ] [ Designated as safety issue: Yes ]
  

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 Lieberman 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.

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