Masala Salvatore, Anselmetti Giovanni Carlo, Marcia Stefano, Massari Francesco, Manca Antonio, Simonetti Giovanni
Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy.
J Spinal Disord Tech. 2008 Jul;21(5):344-8. doi: 10.1097/BSD.0b013e3181454630.
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.
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.
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.
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.
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.
本研究旨在评估经皮椎体成形术的有效性和安全性，这是一种治疗因骨折或多发性骨髓瘤脊柱受累导致的严重溶骨性病变引起的椎体疼痛的新技术。
脊柱溶骨性病变常与血液系统恶性肿瘤相关，其原因包括疾病的原发部位（多发性骨髓瘤，很少见淋巴瘤）或强化糖皮质激素治疗的继发效应。
我们治疗了64例患者（34例男性，30例女性；平均年龄71.4±9.6岁），这些患者脊柱疼痛，对常规药物治疗（镇痛药、卧床休息、使用矫形器械支撑超过3周）无效，且无神经体征。
该治疗能迅速缓解疼痛，并显著增强椎体抵抗力。据报告，所有患者术前平均疼痛水平为8.04±1.4，而在1个月和6个月随访期的平均疼痛水平分别为1.82±1.84和1.92±1.68。尽管术前和术后数字疼痛评分有统计学显著降低（P<0.01），但1个月和6个月时的疼痛水平无统计学显著性。在硬膜外或椎间孔区域未观察到聚甲基丙烯酸甲酯渗漏或静脉丛受累导致的肺栓塞并发症等与手术相关的并发症。
椎体成形术被广泛认为是治疗血液系统恶性肿瘤所致肿瘤性椎体定位的一种有效、简单且安全的替代技术。在放疗前也可进行聚甲基丙烯酸甲酯注射，在治疗失败或局部复发时，可增强其对疼痛的延迟镇痛作用。
