Neuro-Interventional Radiology Unit, Monash Imaging Monash Health, Clayton, VIC, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
Eur Spine J. 2021 Oct;30(10):2825-2838. doi: 10.1007/s00586-021-06955-5. Epub 2021 Aug 14.
Up to 70% of multiple myeloma (MM) patients develop vertebral metastasis and subsequent pathological vertebral fractures (PVF). With contemporary systemic therapies, life expectancy of MM patients has improved drastically, and the need to manage pain and associated disability from PVF is increasingly a high priority. The aim of this review is to provide an updated comprehensive synthesis of evidence in the use of vertebral augmentation, including percutaneous vertebroplasty (PV) and balloon kyphoplasty (BKP), to treat MM-related PVF.
A comprehensive multi-database search in accordance with PRISMA guidelines was performed up to 10 February 2021. Relevant English language articles were selected and critically reviewed.
A total of 23 clinical studies have been included in the review. PV and BKP showed significant pain and functional improvements in terms of analgesia requirements, Cervical Spine Function Score, Eastern Cooperative Oncology Group scale, EQ-5D score, Karnofsky score, Neck Pain Disability Index, Oswestry Disability Index, Short form-36 (SF-36) questionnaire and VAS pain scale. Both procedures also reported promising radiographic outcomes in terms of vertebral height improvement, maintenance and restoration, as well as kyphotic deformity correction. Asymptomatic cement leakage was commonly reported. There was no significant difference between the two procedures.
PV and BKP are safe and effective procedure that offers pain relief, reduction in pain associated disability and reduction of fracture incidence. Its minimally invasive approach is associated with minimal morbidity risk, making it a viable option in frail patients.
Narrative review.
多达 70%的多发性骨髓瘤（MM）患者会发生脊柱转移和随后的病理性脊柱骨折（PVF）。随着当代系统治疗的发展，MM 患者的预期寿命有了显著提高，因此管理 PVF 引起的疼痛和相关残疾的需求变得越来越重要。本文旨在对脊柱骨水泥强化治疗 MM 相关 PVF 的应用进行综合证据的更新综述。
根据 PRISMA 指南进行了全面的多数据库检索，检索时间截至 2021 年 2 月 10 日。选择并批判性地回顾了相关的英文文章。
共纳入了 23 项临床研究。PV 和 BKP 在镇痛需求、颈椎功能评分、东部肿瘤协作组量表、EQ-5D 评分、卡氏评分、颈部疼痛残疾指数、Oswestry 残疾指数、简短形式 36 项健康调查量表（SF-36）问卷和 VAS 疼痛量表等方面均显著改善疼痛和功能。两种手术在椎体高度改善、维持和恢复以及后凸畸形矫正方面均取得了有前景的影像学结果。常见无症状性水泥渗漏。两种手术之间没有显著差异。
PV 和 BKP 是安全有效的治疗方法，可缓解疼痛、减轻与疼痛相关的残疾并降低骨折发生率。其微创方法相关的发病率低，使它成为体弱患者的可行选择。
IV 级：叙述性综述。
