Department of Neuroradiology, Hôpital Nord, 2 place Victor Pauchet, 80054 Amiens, France.
Radiology. 2010 Mar;254(3):882-90. doi: 10.1148/radiol.09081698.
To evaluate the feasibility, efficacy, and safety of percutaneous vertebroplasty (PV) in the treatment of pathologic fractures owing to malignancy with epidural involvement, with or without neurologic symptoms of spinal cord or cauda equina compression.
This study was approved by the local ethics committee; informed consent was obtained from all patients. This retrospective review was performed for 51 consecutive patients with metastatic disease or multiple myeloma treated by means of vertebroplasty, who presented with at least one vertebral lesion with epidural involvement, with or without clinical symptoms of spinal cord or cauda equina compression. All patients with neurologic deficit were terminally ill. A neurologic examination was performed before and after treatment in all patients. All imaging examinations and treatments were reviewed, and chi(2), Mann Whitney, or Fisher exact testing was performed for univariate analysis of variables.
A total of 74 vertebrae were treated in 51 patients, 22 women and 29 men with a mean age of 62.5 years (range, 28-85 years). Fifteen (29%) patients presented symptoms of complete or incomplete spinal cord or cauda equina compression before vertebroplasty and no further clinical deterioration was observed after treatment. The analgesic efficacy of vertebroplasty was satisfactory for 94% (48 of 51) of patients after 1 day, 86% (31 of 36) patients after 1 month, and 92% (11 of 12) patients after 1 year. One patient with no clinical neurologic deficit before treatment experienced symptoms of cauda equina compression 2 days after vertebroplasty. No other major complication was observed.
The feasibility, efficacy, and safety of PV were confirmed in patients experiencing pain related to malignant spinal tumors with epidural extension, with a low complication rate. PV should become part of the palliative analgesic treatment for such patients. (c) RSNA, 2010.
评估经皮椎体成形术（PV）治疗伴有或不伴有脊髓或马尾神经受压的硬膜外受累恶性肿瘤病理性骨折的可行性、疗效和安全性。
本研究获得了当地伦理委员会的批准；所有患者均获得了知情同意。回顾性分析了 51 例接受椎体成形术治疗的转移性疾病或多发性骨髓瘤患者，这些患者至少有一个伴有硬膜外受累的椎体病变，伴有或不伴有脊髓或马尾神经受压的临床症状。所有有神经功能缺损的患者均为终末期疾病。所有患者在治疗前后均进行神经检查。回顾所有影像学检查和治疗，并进行 χ(2)、Mann-Whitney 或 Fisher 确切检验，对变量进行单因素分析。
51 例患者共治疗 74 个椎体，其中 22 例为女性，29 例为男性，平均年龄为 62.5 岁（范围 28-85 岁）。15 例（29%）患者在椎体成形术前出现完全或不完全脊髓或马尾神经受压的症状，治疗后未见进一步临床恶化。94%（48/51）的患者在 1 天、86%（31/36）的患者在 1 个月、92%（11/12）的患者在 1 年后对椎体成形术的镇痛效果满意。1 例治疗前无临床神经功能缺损的患者在椎体成形术后 2 天出现马尾神经受压症状。未观察到其他重大并发症。
在伴有硬膜外扩展的恶性脊柱肿瘤引起疼痛的患者中，PV 的可行性、疗效和安全性得到了证实，且并发症发生率低。PV 应成为此类患者姑息性镇痛治疗的一部分。
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