title: Treatment of MM-associated spinal fracture with percutaneous vertebroplasty (PVP) and chemotherapy.
abstract: OBJECTIVE
  To investigate the effect of treatment of multiple myeloma (MM)-associated spinal fracture with percutaneous vertebroplasty (PVP) and chemotherapy.
  
  
  METHODS
  Patients with MM-associated spinal fracture were randomly divided into combined (PVP and chemotherapy) treatment group (n = 38) and single chemotherapy group (n = 38). For the combined treatment group, bone cement was injected into vertebral body via DSA guided-percutaneous puncture. M2 scheme was used for both groups. And a 5-year follow-up was conducted for the study.
  
  
  RESULTS
  At the 1-year follow-up visits, PVP combined with chemotherapy achieved complete remission (CR) in six patients (15.8%); near complete remission (nCR) in ten patients (26.30%); partial remission (PR) in nine patients (23.7%); minimal response (MR) in three patients (7.9%); no change (NC) in four patients (10.5%), and disease progression (DP) in five patients (13.2%). Only chemotherapy alone resulted in 3 CR (7.9%); 8 nCR (26.30%); 19 PR (77.5%); 4 MR (17.5%); 4 NC (17.5%), and 2 DP (5.0%). While the overall response rate (ORR) in the combined treatment group (65.8%) and the single chemotherapy group (50.0%) were significantly different, their visual analog pain scales (3.01 ± 0.62 and 5.97 ± 0.40, respectively) and Karnofsky performance scores (89.4 ± 6.3 and 80.3 ± 7.2, respectively) were significantly improved after treatment (P = 0.032 and P = 0.002, respectively). And the ORR between the two groups were significantly different (P = 0.001).
  
  
  CONCLUSIONS
  Percutaneous vertebroplasty is a minimally invasive surgery for MM-associated pathologic fracture. PVP had the characteristics of minimal trauma, easy operation and less complication. PVP can achieve long-term analgesic effect, and enhance the spinal stability.
authors.affiliation: Department of Orthopedics, Tumor Hospital of Yunnan Province, The Third Affiliated Hospital of Kunming Medical College, Kunming 650118, Yunnan, People's Republic of China. yangzuozhang@163.com
authors.forename: Zuozhang
authors.initials: Z
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Tan
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Xu
authors.forename: Hongpu
authors.initials: H
authors.lastname: Sun
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
authors.forename: Ruilian
authors.initials: R
authors.lastname: Zhao
authors.forename: Jiaping
authors.initials: J
authors.lastname: Wang
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009101:Multiple Myeloma / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D010147:Pain Measurement; D012074:Remission Induction; D016103:Spinal Fractures / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*