J Korean Med Sci.  2015 Jan;30(1):88-94. 10.3346/jkms.2015.30.1.88.

Bone Cement Augmentation Procedures for Spinal Pathologic Fractures by Multiple Myeloma

• Ha KY
• Min CK
• Seo JY
• Kim YH
• Ahn JH
• Hyun NM
• Kim YC

• KMID: 2155452
• DOI: http://doi.org/10.3346/jkms.2015.30.1.88

Abstract

Efficacy and safety of bone cement augmentations for spinal pathologic fractures related to multiple myeloma, and usefulness of radionuclide studies for surgical decision were retrospectively evaluated. Forty eight vertebrae from 27 patients for bone cement augmentation procedures and 48 vertebrae from 29 patients for conservative treatment were enrolled. Clinical results using visual analogue scale (VAS) and Oswestry disability index (ODI), and radiologic results were assessed. For clinical decisions on treatment of spinal pathologic fracture, bone scan or single photon emission computed tomography was done for 20 patients who underwent surgery. Mean follow-up was 16.8 months. In terms of clinical results, immediate pain relief was superior in the operated group to that in the conservative group. ODI, maintenance of vertebral height and local kyphotic angle at the last follow-up were superior in the operated group in comparison to the conservative group. At one year follow-up, cumulative survival rate were 77.4% and 74.7% in the operated and conservative groups, respectively (log rank test> 0.05). Leakage of bone cement was noted at 10 treated vertebrae. Bone cement augmentations presented short-term pain relief for spinal pathologic fractures by myeloma with relative safety in highly selected patients, and radionuclide imaging studies were useful for the surgical decision on these procedures.

Keyword

Multiple Myeloma; Spine; Fractures, Spontaneous; Bone Cements

MeSH Terms

Aged
Bone Cements/*therapeutic use
Female
Humans
Male
Middle Aged
Multiple Myeloma/*pathology
Pain Measurement
Retrospective Studies
Severity of Illness Index
Spinal Fractures/*radionuclide imaging/*surgery
Spine/radionuclide imaging/*surgery
Treatment Outcome
Bone Cements

Figure

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  Fig. 1 A 70-yr-old woman was diagnosed as multiple myeloma stage III b by laboratory tests and bone marrow biopsy. T1-weighted (A) and fat-suppression MRIs (B) show pathologic fracture at the T12 with multiple nodular signal changes involving multiple vertebrae. Single positron emission CT scan (C) shows abnormal hot uptake at the T12 and L2 vertebrae. Kyphoplasty was performed (D).

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  Fig. 2 Distribution of the affected vertebrae in this study. D indicates the dorsal spine. L indicates the lumbar spine.

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  Fig. 3 Clinical results. (A) Pain reduction at 1 month postoperatively is superior to that of the conservative treatment. (B) At the 1 month and last follow-up, the scores of ODI show a significant difference between the two groups (Group I indicates surgery group, group II indicates supportive treatment, *indicates statistically significant differences).

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  Fig. 4 Radiomorphological results. The maintenance of local kyphosis (A) and restoration of height loss (B) are superior in the surgery group to those in the conservative treatment. And these results were also maintained at the last follow-ups (Group I indicates surgery group, group II indicates supportive treatment, *indicates statistically significant differences).

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