title: PMMA vertebroplasty in patients with malignant vertebral destruction of the thoracic and lumbar spine.
abstract: OBJECTIVE
  Patients with osteolytic metastases frequently suffer from serious local and radicular pain. Pathophysiologically, local pain arises from skeletal instability, whereas radicular pain originates from compression of nerve roots by local tumor growth. Causal treatment of osteolytic metastases in disseminated malignant disease is very difficult. Resection of vertebrae, in combination with ventro-dorsal stabilization, is a complex treatment for patients with a limited life expectancy. Percutaneous polymethylmethacrylate (PMMA) vertebroplasty is a new and easy method of relieving patients' pain. In addition, it is both cost effective and safe. Pain is reduced immediately after treatment. Due to the regained vertebral stability, early mobilization of the patients is possible.
  
  
  METHODS
  A total of 22 patients with osteolytic malignancies of the thoracic and lumbar spine were treated with PMMA vertebroplasty. Prior to and after surgery, then six weeks and six months after discharge from hospital, patients answered the Oswestry Low Back Pain Disability (OLBPD) Questionnaire for assessment of treatment-related change in disability. Percutaneous vertebroplasty was performed in a total of 19 patients. In three patients with tumor related compression of nerve roots an open neurolysis was performed followed by vertebroplasty.
  
  
  RESULTS
  A total of 86% of patients reported a significant pain reduction. Vertebroplasty was highly beneficial for patients with pain related to local instability of the spine, but less so in patients with additional nerve root compression. Extravasation of PMMA beyond the vertebral margins was observed in 23% of the cases. No treatment-related clinical or neurological complications were seen.
  
  
  CONCLUSIONS
  PMMA vertebroplasty is a useful and safe method of pain relief for patients with malignant osteolytic diseases of the thoracic and lumbar spine.
authors.affiliation: Neurosurgical Clinic, Universitätsklinikum, Justus-Liebig-Universität, Giessen, Germany. michael.winking@neuro.med.uni-giessen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Winking
authors.forename: Jens-Peter
authors.initials: JP
authors.lastname: Stahl
authors.forename: Matthias
authors.initials: M
authors.lastname: Oertel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schnettler
authors.forename: Dieter-Karsten
authors.initials: DK
authors.lastname: Böker
references.citation: Radiology. 1996 Aug;200(2):525-30
references.pmid: 8685351
references.citation: Spine (Phila Pa 1976). 1990 Nov;15(11):1110-3
references.pmid: 1702559
references.citation: Spine (Phila Pa 1976). 1997 Oct 1;22(19):2278-82
references.pmid: 9346149
references.citation: Spine (Phila Pa 1976). 1997 Dec 15;22(24 Suppl):38S-42S
references.pmid: 9431643
references.citation: Spine (Phila Pa 1976). 2000 Apr 15;25(8):923-8
references.pmid: 10767803
references.citation: Radiol Clin North Am. 1998 May;36(3):533-46
references.pmid: 9597071
references.citation: Physiotherapy. 1980 Aug;66(8):271-3
references.pmid: 6450426
references.citation: Rev Rhum Engl Ed. 1997 Mar;64(3):177-83
references.pmid: 9090767
references.citation: Orthopade. 1998 May;27(5):269-73
references.pmid: 9646317
references.citation: J Rheumatol. 1999 Oct;26(10):2222-8
references.pmid: 10529144
references.citation: Spine (Phila Pa 1976). 1994 Oct 1;19(19):2139-43
references.pmid: 7809744
references.citation: Clin Radiol. 1988 Sep;39(5):547-50
references.pmid: 2460278
references.citation: Pain. 1998 Apr;75(2-3):273-9
references.pmid: 9583763
references.citation: Bone. 1999 Aug;25(2 Suppl):11S-15S
references.pmid: 10458267
references.citation: Neurosurgery. 2001 Nov;49(5):1105-14; discussion 1114-5
references.pmid: 11846904
references.citation: J Neuroradiol. 1997 Jun;24(1):45-59
references.pmid: 9303944
references.citation: J Bone Joint Surg Am. 1974 Mar;56(2):311-2
references.pmid: 4452690
references.citation: Neurochirurgie. 1987;33(2):166-8
references.pmid: 3600949
references.citation: Radiology. 1996 Apr;199(1):241-7
references.pmid: 8633152