Department of Diagnostic and Interventional Radiology, Ospedale Ferrarotto, via Citelli 6, 95124, Catania, Italy.
Skeletal Radiol. 2011 Jul;40(7):913-9. doi: 10.1007/s00256-011-1114-6. Epub 2011 Feb 28.
The goal of this study was to specifically address the incidence of dorsal leakage when performing vertebroplasty in patients with posterior wall osteolysis or fracture, by using a delayed injection of cement with the aim of increasing its viscosity.
We prospectively reviewed the records of 24 patients (13 women, 11 men; age range 42-67 years; mean age 54.7) with diagnosis of multiple myeloma (MM) who underwent 34 vertebroplasties between January 2007 and January 2010 for painful osteolytic localization of MM with dorsal cortical osteolysis or fracture. All vertebroplasties were performed with an 8 min delay, which was half of the allotted injecting time given for the chosen cement. In 11 cases there were fractures involving the posterior wall, in 1 case with dorsal fragment dislocation, and in 33 cases there was dorsal cortical osteolysis. All of the patients showed no response to standard treatments such as radiotherapy, chemotherapy, and analgesic treatments.
Technical success was achieved in all cases. In 20 patients, we treated only one high-risk vertebral lesion, in six patients we treated two segments, and in one patient we treated three segments. All patients experienced improvement in symptoms after the procedure as demonstrated by improved visual analogue scores (VAS) and performance status (PS) and decreased doses of analgesic. There was a dorsal leakage in 2/34 (5.8%) treated vertebral bodies in which an epidural space tumor extension was also diagnosed, without increasing neurological symptoms after the intervention.
From these results vertebroplasty with delayed injection of cement is safe and effective in the treatment of vertebral localization of myeloma with osteolysis or fracture of the posterior vertebral wall.
本研究的目的是专门探讨在存在后柱骨溶解或骨折的患者中进行椎体成形术时发生骨水泥渗漏的发生率，方法是延迟注射骨水泥以增加其粘性。
我们前瞻性地回顾了 2007 年 1 月至 2010 年 1 月期间因多发性骨髓瘤（MM）所致的多灶性溶骨性骨痛定位而行 34 例椎体成形术的 24 例患者（13 名女性，11 名男性；年龄 42-67 岁；平均年龄 54.7 岁）的记录。所有椎体成形术均延迟 8 分钟进行，这是所选骨水泥注射时间的一半。在 11 例中存在涉及后柱的骨折，在 1 例中存在背侧骨块脱位，在 33 例中存在背侧皮质骨溶解。所有患者对标准治疗（如放疗、化疗和止痛治疗）均无反应。
所有病例均获得技术成功。在 20 例患者中，我们仅治疗了 1 个高风险椎体病变，在 6 例患者中治疗了 2 个节段，在 1 例患者中治疗了 3 个节段。所有患者的症状均在手术后得到改善，表现为视觉模拟评分（VAS）和表现状态（PS）改善以及止痛剂量减少。在 34 个治疗的椎体中，有 2 个（5.8％）发生了背侧渗漏，其中还诊断出硬膜外肿瘤扩展，但干预后无神经症状加重。
从这些结果来看，延迟注射骨水泥的椎体成形术在治疗多发性骨髓瘤的溶骨性骨或后柱骨折的椎体定位中是安全有效的。
