Rocha Romero Andrés, Hernández-Porras Berenice Carolina, Plancarte-Sanchez Ricardo, Espinoza-Zamora José Ramiro, Carvajal Gabriel, Ramos Natarén Reyna Guadalupe, De Los Reyes Pacheco Victor Alfonso, Salazar Carrera Ivan Hamiyd
National Cancer Institute Mexico City, Mexico City, México.
National Pain and Palliative Care Center, San Jose, Costa Rica.
Pain Med. 2020 Nov 1;21(11):3018-3023. doi: 10.1093/pm/pnaa018.
Vertebroplasty is a percutaneous minimally invasive procedure indicated for vertebral collapse pain treatment. Among the known complications of the procedure is the augmented risk of new vertebral fractures. There are no specific studies in this patient population describing the risk of new vertebral fractures after vertebroplasty. This study analyzed risk factors associated with new vertebral fractures after vertebroplasty in patients with multiple myeloma.
Observational retrospective study in patients with multiple myeloma. The data collection took place from January 1, 2010, to December 30, 2017, at the National Cancer Institute. Clinical data and procedural variables such as cement volume, cement leaks, fracture level, number of treated vertebrae, pedicular disease, and cement distribution pattern, with two years follow-up, were analyzed with the Wilcoxon test, and a logistic regression model was used to identify risk factors related to new vertebral fractures. A confidence interval of 95% was used for analysis.
At one-year follow-up, 30% of fractures were reported after vertebroplasty, most of them at low thoracic and lumbar level (50% adjacent level). Vertebroplasty was most commonly performed at the thoracolumbar and lumbar area. We demonstrated a 70.7% median numerical rating scale reduction at one-year follow-up; a significant decrease in opioid consumption occurred only during the first month.
Pedicle involvement, disc leakage, cement volume, thoracolumbar and lumbar level, and number of treated vertebrae by intervention are important risk factors when performing vertebroplasty. Prospective randomized studies are needed to evaluate these factors in this specific population.
椎体成形术是一种用于治疗椎体塌陷疼痛的经皮微创手术。该手术已知的并发症包括新发椎体骨折风险增加。在这一患者群体中，尚无专门研究描述椎体成形术后新发椎体骨折的风险。本研究分析了多发性骨髓瘤患者椎体成形术后与新发椎体骨折相关的危险因素。
对多发性骨髓瘤患者进行观察性回顾性研究。数据收集于2010年1月1日至2017年12月30日在美国国立癌症研究所进行。对临床数据和手术变量，如骨水泥体积、骨水泥渗漏、骨折节段、治疗椎体数量、椎弓根病变和骨水泥分布模式等，进行了为期两年的随访，并采用Wilcoxon检验进行分析，同时使用逻辑回归模型确定与新发椎体骨折相关的危险因素。分析采用95%的置信区间。
在一年的随访中，椎体成形术后报告有30%的骨折发生，其中大部分发生在胸腰段和腰段低位（50%为相邻节段）。椎体成形术最常施行于胸腰段和腰段。我们在一年的随访中显示数字评分量表中位数降低了70.7%；仅在第一个月阿片类药物消耗量显著减少。
椎弓根受累、椎间盘渗漏、骨水泥体积、胸腰段和腰段以及干预治疗的椎体数量是进行椎体成形术时的重要危险因素。需要进行前瞻性随机研究以评估这一特定人群中的这些因素。
