title: Vertebroplasty in multiple myeloma with osteolysis or fracture of the posterior vertebral wall. Usefulness of a delayed cement injection.
abstract: OBJECTIVE
  The goal of this study was to specifically address the incidence of dorsal leakage when performing vertebroplasty in patients with posterior wall osteolysis or fracture, by using a delayed injection of cement with the aim of increasing its viscosity.
  
  
  METHODS
  We prospectively reviewed the records of 24 patients (13 women, 11 men; age range 42-67 years; mean age 54.7) with diagnosis of multiple myeloma (MM) who underwent 34 vertebroplasties between January 2007 and January 2010 for painful osteolytic localization of MM with dorsal cortical osteolysis or fracture. All vertebroplasties were performed with an 8 min delay, which was half of the allotted injecting time given for the chosen cement. In 11 cases there were fractures involving the posterior wall, in 1 case with dorsal fragment dislocation, and in 33 cases there was dorsal cortical osteolysis. All of the patients showed no response to standard treatments such as radiotherapy, chemotherapy, and analgesic treatments.
  
  
  RESULTS
  Technical success was achieved in all cases. In 20 patients, we treated only one high-risk vertebral lesion, in six patients we treated two segments, and in one patient we treated three segments. All patients experienced improvement in symptoms after the procedure as demonstrated by improved visual analogue scores (VAS) and performance status (PS) and decreased doses of analgesic. There was a dorsal leakage in 2/34 (5.8%) treated vertebral bodies in which an epidural space tumor extension was also diagnosed, without increasing neurological symptoms after the intervention.
  
  
  CONCLUSIONS
  From these results vertebroplasty with delayed injection of cement is safe and effective in the treatment of vertebral localization of myeloma with osteolysis or fracture of the posterior vertebral wall.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Ospedale Ferrarotto, via Citelli 6, 95124, Catania, Italy. antodoc@yahoo.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Basile
authors.forename: Maide
authors.initials: M
authors.lastname: Cavalli
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiumara
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Raimondo
authors.forename: Elena
authors.initials: E
authors.lastname: Mundo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caltabiano
authors.forename: Flavio
authors.initials: F
authors.lastname: Arcerito
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Patti
authors.forename: Antonio
authors.initials: A
authors.lastname: Granata
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
mesh_terms: D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy*; D010014:Osteolysis / Q000209:etiology / Q000628:therapy*; D016103:Spinal Fractures / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements