title: Cement leakage: safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions.
abstract: OBJECTIVE
  To evaluate and address the safety of vertebroplasty (VP) and kyphoplasty (KP) in terms of rate and type of cement leakage in the treatment of Multiple Myeloma (MM) vertebral fractures.
  
  
  METHODS
  A total number of 37 treated vertebrae were evaluated post-operatively by using standard X-rays and CT scan looking for a cement leakage. VP was done using a monoportal approach in all cases (18 treated levels, group A), while KP was done using a monopedicular approach in 9 levels (group B1) and using a bipedicular approach in the remaining 10 levels (group B2). A computed tomography was used to establish the presence of any cement leakage and to determine its localization.
  
  
  RESULTS
  Vertebral augmentation through VP and KP provides immediate pain relief and an improvement of the quality of life of patients affected by MM but it is gravated by high risk of cement leakage. Cement extravasation occurred in 27.7% of total VP procedures and in 21.05% of total KP procedures, but considering the whole number of treated levels, it was more common in multi-level VP and in bipedicular KP, in which a higher quantity of cement was employed.
  
  
  CONCLUSIONS
  KP procedure in these patients is slightly less risky but we suggest doing it with a monopedicular approach. It's mandatory to use an high viscosity cement and we suggest not to use an amount of PMMA over 2 cc and a previous treatment with bone marrow transplant is related to a lower risk of cement leakage.
authors.affiliation: Spine Surgery Division, Gaetano Pini Orthopaedic Institute, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy. giovanniandrea.lamaida@gpini.it
authors.forename: Giovanni Andrea
authors.initials: GA
authors.lastname: La Maida
authors.forename: Laura Serena
authors.initials: LS
authors.lastname: Giarratana
authors.forename: Alberto
authors.initials: A
authors.lastname: Acerbi
authors.forename: Valentina
authors.initials: V
authors.lastname: Ferrari
authors.forename: Giuseppe Vincenzo
authors.initials: GV
authors.lastname: Mineo
authors.forename: Bernardo
authors.initials: B
authors.lastname: Misaggi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D015331:Cohort Studies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D058498:Kyphoplasty / Q000009:adverse effects / Q000379:methods*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009101:Multiple Myeloma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000009:adverse effects / Q000379:methods*
chemical_list: D001843:Bone Cements