La Maida Giovanni Andrea, Sala Francesco, Callea Giovanna, Capitani Dario, Singh Saurabh
Department of Orthopaedics, Niguarda Hospital, Milan, Italy.
Asian Spine J. 2011 Sep;5(3):162-8. doi: 10.4184/asj.2011.5.3.162. Epub 2011 Aug 12.
A retrospective cohort study.
To analyze differences in between the unipedicular vs. bipedicular balloon kyphoplasty for the treatment of multiple myeloma lesions.
Both vertebroplasty and kyphoplasty are reported to be effective for the treatment of vertebral compression fractures in multiple myeloma patients. Kyphoplasty is often performed with a bipedicular approach while vertebroplasty with a monopedicular approach. Monopedicular kyphoplasty is investigated as a viable surgical technique alternatively in comparison with the bipedicular method.
We performed 37 vertebral body augmentation procedures, 18 vertebroplasty (group A) and 19 kyphoplasty, 9 unipedicular approaches (group B1) and 10 bipedicular approaches (group B2), on 14 patients affected by multiple myeloma with a mean clinical and radiographic follow up of more than 12 months.
Both kyphoplasty techniques lead to a better postoperative improvement of the vertebral height and kyphotic deformity if compared with the vertebroplasty, with a statistical significance for the body height restoration only (p = 0.0066). The unipedicular and the bipedicular kyphoplasty have similar results in term of kyphotic deformity correction and height restoration. The 85.7% (12/14) of the patients had an immediate improvement of the pain and no difference between the vertebroplasty and kyphoplasty groups were observed regarding the pain. We observed a 24.3% of cement leakage in all groups with no clinical symptoms and noticed that the risk of extravasations was higher in multilevel treatment, in bipedicular kyphoplasty procedures and in patients not treated previously with a bone marrow transplant.
Both vertebroplasty and kyphoplasty are effective in treating vertebral compression fracture due to multiple myeloma. Unipedicular kyphoplasty could give equivalent results as with bipedicular kyphoplasty in multilevel disease, aiming only to restore the sagittal alignment of the spine and the height of the vertebral body especially at the thoracolumbar spinal segment.
一项回顾性队列研究。
分析单节段与双节段球囊后凸成形术治疗多发性骨髓瘤骨病变的差异。
据报道，椎体成形术和后凸成形术对治疗多发性骨髓瘤患者的椎体压缩骨折均有效。后凸成形术通常采用双节段入路，而椎体成形术采用单节段入路。与双节段方法相比，单节段后凸成形术作为一种可行的手术技术进行了研究。
我们对14例多发性骨髓瘤患者进行了37例椎体强化手术，其中18例椎体成形术（A组）和19例后凸成形术，9例单节段入路（B1组）和10例双节段入路（B2组），平均临床和影像学随访超过12个月。
与椎体成形术相比，两种后凸成形术技术均能使术后椎体高度和后凸畸形得到更好改善，仅椎体高度恢复具有统计学意义（p = 0.0066）。单节段和双节段后凸成形术在矫正后凸畸形和恢复高度方面结果相似。85.7%（12/14）的患者疼痛立即改善，椎体成形术和后凸成形术组在疼痛方面未观察到差异。我们在所有组中观察到24.3%的骨水泥渗漏且无临床症状，并注意到在多节段治疗、双节段后凸成形术以及未接受过骨髓移植治疗的患者中，骨水泥外渗风险更高。
椎体成形术和后凸成形术在治疗多发性骨髓瘤所致椎体压缩骨折方面均有效。在多节段疾病中，单节段后凸成形术可产生与双节段后凸成形术等效的结果，其目的仅为恢复脊柱矢状位对线和椎体高度，尤其是在胸腰段脊柱节段。
