Department of Clinical Radiology, Ludwig-Maximilians-Universität Munchen, Munich, Germany.
Diagn Interv Radiol. 2012 Jan-Feb;18(1):111-20. doi: 10.4261/1305-3825.DIR.4226-11.1. Epub 2011 Oct 17.
This study aimed to assess the results of computed tomography (CT) fluoroscopy-guided vertebroplasty in patients with multiple myeloma, focusing on the frequency and clinical impact of polymethylmethacrylate (PMMA) leaks.
From December 2001 to August 2008, 39 patients (17 females, 22 males; mean age, 65±7 years) with multiple myeloma suffering from painful spinal osteolyses underwent vertebroplasty. A total of 67 vertebrae were treated in 44 sessions under CT fluoroscopy (single-slice, 4-row CT, and 16-row CT). In the planning CT scan, osteolytic destruction (i.e., none, ≤25%, ≤50%, ≤75%, or ≤100%) was assessed regarding the vertebral cross-sectional area, the cortical border of the spinal canal, and the outer circumference. CT performed after vertebroplasty was used to detect local PMMA leaks. Patient charts were retrospectively reviewed with special respect to peri and postinterventional adverse events. Clinical outcomes were assessed on a visual analog scale (VAS) 24 hours before, 24 hours after, and 6 months after vertebroplasty.
Overall, 37.3%, 12.0%, and 6.0% of vertebrae showed at least 50% osteolytic involvement of the cross-sectional area, spinal canal, and outer vertebral cortex, respectively. Intradiscal, intraspinal, paravertebral, and intercostovertebral/posterolateral leaks were seen in 21.6%, 35.1%, 43.3%, and 0% of vertebrae, respectively. The ratio of basivertebral to segmental venous leaks was 16.2%/40.5%. No major complications occurred. The mean VAS score decreased significantly (P < 0.05) from 6.4 at 24 hours before vertebroplasty to 3.2 at a mean follow-up of 9.0 months.
Vertebroplasty in multiple myeloma can be performed safely under CT fluoroscopy, even with substantial destruction of the vertebral cross-sectional area or cortical bone. A high clinical success rate was achieved, regardless of whether PMMA leaks were present.
本研究旨在评估 CT 透视引导下椎体成形术治疗多发性骨髓瘤患者的结果，重点关注聚甲基丙烯酸甲酯（PMMA）渗漏的频率和临床影响。
2001 年 12 月至 2008 年 8 月，39 例（女性 17 例，男性 22 例；平均年龄 65±7 岁）多发性骨髓瘤伴脊柱溶骨性疼痛患者接受椎体成形术治疗。共 67 个椎体在 44 次 CT 透视（单排、4 排和 16 排 CT）下进行治疗。在计划 CT 扫描中，根据椎体横截面积、椎管皮质边界和外周长评估溶骨性破坏（即无破坏、≤25%、≤50%、≤75%或≤100%）。椎体成形术后行 CT 检查以检测局部 PMMA 渗漏。回顾性分析患者病历，特别关注围手术期和术后不良事件。在椎体成形术前 24 小时、术后 24 小时和术后 6 个月，采用视觉模拟评分（VAS）评估临床疗效。
总体而言，37.3%、12.0%和 6.0%的椎体分别有至少 50%的横截面积、椎管和外椎体皮质受累。椎间盘内、椎管内、椎旁和肋椎/后外侧渗漏分别见于 21.6%、35.1%、43.3%和 0%的椎体。基底静脉与节段性静脉渗漏的比例为 16.2%/40.5%。无严重并发症发生。VAS 评分从椎体成形术前 24 小时的 6.4 分显著降低（P < 0.05）至平均 9.0 个月随访时的 3.2 分。
即使在椎体横截面积或皮质骨严重破坏的情况下，多发性骨髓瘤患者也可在 CT 透视引导下安全地进行椎体成形术。无论是否存在 PMMA 渗漏，均取得了较高的临床成功率。
