Department of Neurosurgery, Instituto Clinico Humanitas, Milan, Italy.
Neurol Sci. 2010 Apr;31(2):151-7. doi: 10.1007/s10072-009-0197-5.
Mechanical stabilization of oncological vertebral fractures with cement augmentation is the first mechanism of pain relief, with or without restoration of vertebral body height. The aim of this study was to assess the safety and efficacy of vertebroplasty for painful vertebral body fractures in patients with multiple myeloma, in each phase of the disease. The authors reviewed a consecutive group of patients with multiple myeloma who underwent vertebroplasty at our Institute between November 2003 and December 2005. Twenty-eight levels were performed on 11 patients during 14 treatment sessions. All patients suffered from intractable back pain, and presented various lesion types (with and without fractures of posterior wall, and with and without epidural disease). The preoperative median visual analog scale (VAS) score was 7. The median duration of symptoms was 1.1 months. Eight patients were ambulating with orthopaedic devices (57%) in the pre-treatment period. Improvement or complete pain relief was observed in all patients (immediately in 8 cases, and after 2 days in 6 cases). The median VAS pain score decreased to 2. There was no symptomatic procedure-related complication. There were three cases (21%) of PMMA leakage: in the disc space in one case (7%), and in the anterior spinal canal in two cases (14%). Complete removal of orthopaedic devices was obtained in five patients (36%). No new deformation or collapse of the treated vertebrae was observed during the follow-up (range 1 day-25 months). In conclusion, vertebroplasty is a safe and efficient procedure in the treatment of painful vertebral body fractures in patients with multiple myeloma, without potential contraindications, such as fractures of the posterior wall or epidural disease. We also treated three and more levels in 28% of cases in a single session without complications. Due to the early pain relief and the low complication rate, it is possible to expand the indication to vertebroplasty for the prophylactic augmentation of those vertebral bodies at risk of fracture in which significant neoplastic substitution of the body is present.
骨水泥增强型机械稳定术是缓解疼痛的第一种机制，无论是否恢复椎体高度。本研究旨在评估经皮椎体成形术治疗多发性骨髓瘤患者疼痛性椎体骨折的安全性和疗效，包括疾病的各个阶段。作者回顾性分析了 2003 年 11 月至 2005 年 12 月期间在我院接受经皮椎体成形术治疗的多发性骨髓瘤患者连续病例。14 次治疗中共有 11 例患者 28 个椎体接受治疗。所有患者均有难治性背痛，且表现出不同的病变类型（有或无后壁骨折，有或无硬膜外疾病）。术前中值视觉模拟评分（VAS）为 7 分。中位症状持续时间为 1.1 个月。8 例患者在治疗前使用矫形器（57%）。所有患者均观察到改善或完全缓解疼痛（8 例即刻缓解，6 例 2 天后缓解）。中值 VAS 疼痛评分降至 2 分。无与症状相关的操作并发症。3 例（21%）发生 PMMA 渗漏：1 例（7%）发生在椎间盘，2 例（14%）发生在前纵韧带。5 例（36%）患者完全去除矫形器。随访期间未发现治疗椎体新的变形或塌陷（随访时间 1 天至 25 个月）。结论，经皮椎体成形术治疗多发性骨髓瘤患者疼痛性椎体骨折安全有效，无潜在禁忌证，如后壁骨折或硬膜外疾病。在单次治疗中，我们还对 28%的病例进行了 3 个或更多节段的治疗，且无并发症。由于早期缓解疼痛和低并发症发生率，有可能扩大经皮椎体成形术的适应证，对那些存在大量肿瘤替代的椎体进行预防性增强，以预防骨折。
