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).