Percutaneous vertebroplasty in multiple myeloma vertebral involvement.
OBJECTIVE
The aim of this study was to assess the effectiveness and safety of percutaneous vertebroplasty, a new technique for the treatment of vertebral pain deriving from fracture or gross osteolytic lesion due to multiple myeloma spinal involvement.


BACKGROUND
Spinal osteolytic lesions are frequently associated with hematologic malignancies due to primary localization of disease (multiple myeloma and rarely lymphoma) or secondary effect of intensive corticosteroid therapy.


METHODS
We treated 64 patients (34 males, 30 females; mean age 71.4+/-9.6 y) with pain refractory to conventional medical therapy (analgesics, bed-rest, bracing with orthopedic devices for more than 3 wk) localized in spine, in the absence of neurologic signs.


RESULTS
This treatment generated swift pain relief associated with an evident augmentation in vertebral resistance. Average preprocedural pain level for all patients was reported to be 8.04+/-1.4 whereas average pain level at 1 and 6 months follow-up period was 1.82+/-1.84 and 1.92+/-1.68, respectively. Although preprocedure and postprocedure demonstrated a statistically significant reduction in numeric pain scores (P<0.01), the pain level at 1 and 6 months was not considered statistically significant. No procedure-related complications were observed in either leakages of polymethylmethacrylate in the epidural or foraminal area or in complications of pulmonary embolism for venous plexus involvement.


CONCLUSIONS
Vertebroplasty is widely considered as an alternative, effective, simple, and safe technique in the treatment of neoplastic vertebral localizations consequent to hematologic malignancies. The same injection of polymethylmethacrylate can be executed before radiation therapy treatment, synergizing its delayed analgesic action to pain, after failure or in the case of local recurrences.
Masala
Salvatore
S
Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy. salva.masala@tiscali.it
Anselmetti
Giovanni Carlo
GC
Marcia
Stefano
S
Massari
Francesco
F
Manca
Antonio
A
Simonetti
Giovanni
G
D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010024:Osteoporosis / Q000139:chemically induced / Q000503:physiopathology / Q000601:surgery; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods* / Q000592:standards
D001843:Bone Cements; D019904:Polymethyl Methacrylate; D011241:Prednisone