Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up.
OBJECTIVE
To determine whether the percentage of vertebral lesion filling and the leakage of methyl methacrylate have any clinical significance at follow-up.


METHODS
Forty percutaneous vertebroplasties were performed for metastases (30 cases) and myeloma (10 cases) in 37 patients. A computed tomographic scan was obtained 1-8 hours after methyl methacrylate injection and was used to assess the percentage of lesion filling by methyl methacrylate and the leakage of methyl methacrylate into the epidural tissues, neural foramina, intervertebral disks, venous plexus, and paravertebral tissue. The results were correlated with those obtained at clinical follow-up.


RESULTS
Partial or complete pain relief was sustained in 36 of 37 patients. Pain relief was not proportional to the percentage of lesion filling. Clinical improvement was maintained in most patients. The 15 epidural leaks, eight intradiskal leaks, and two venous leaks of methyl methacrylate had no clinical importance. Two of eight foraminal leaks produced nerve root compression that required decompressive surgery. One of 21 paravertebral leaks produced transitory femoral neuropathy.


CONCLUSIONS
Pain relief can occur despite insufficient lesion filling. In most patients, intradiskal and paravertebral leaks of cement had no clinical importance.
Cotten
A
A
Department of Skeletal Radiology, Hôpital B-CHRU de Lille, France.
Dewatre
F
F
Cortet
B
B
Assaker
R
R
Leblond
D
D
Duquesnoy
B
B
Chastanet
P
P
Clarisse
J
J
D001843:Bone Cements / Q000627:therapeutic use*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D020366:Methylmethacrylate; D008768:Methylmethacrylates / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging / Q000628:therapy*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D015642:Radiology, Interventional; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D013131:Spine / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D001843:Bone Cements; D008768:Methylmethacrylates; D020366:Methylmethacrylate