Kyphoplasty for Patients With Multiple Myeloma Is a Safe Surgical Procedure: Results From a Large Patient Cohort

Huber, F.-X.; McArthur, Nicholas; Tanner, Michael C.; Gritzbach, Bernd; Schoierer, Oliver; Rothfischer, Wolfram; Krohmer, Gerhard; Lessl, Erich; Baier, Martin; Meeder, P. J.; Kasperk, Christian

doi:10.3816/clm.2009.n.073

Cited by 30 publications

(14 citation statements)

References 50 publications

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“…26 However, in the present series there was none of the symptomatic cement leakage reported in other studies. 11,19,25,46 The rate of cement-associated lung embolism was 4% in the present study.…”

Section: Symptomatic Leakage Is Rarecontrasting

confidence: 54%

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Mueller

Baldauf

Marx

et al. 2016

SPI

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OBJECTIVE Loosening and pullout of pedicle screws are well-known problems in pedicle screw fixation surgery. Augmentation of pedicle screws with bone cement, first described as early as 1975, increases the pedicle-screw interface and pullout force in osteoporotic vertebrae. The aim of the present study was to identify cement leakage and pulmonary embolism rates in a large prospective single-center series of pedicle screw augmentations. METHODS All patients who underwent cement-augmented pedicle screw placement between May 2006 and October 2010 at the authors' institution were included in this prospective cohort study. Perivertebral cement leakage and pulmonary cement embolism were evaluated with a CT scan of the area of operation and with a radiograph of the chest, respectively. RESULTS A total of 98 patients underwent placement of cement-augmented pedicle screws; 474 augmented screws were inserted in 237 vertebrae. No symptomatic perivertebral cement leakage or symptomatic pulmonary cement embolism was observed, but asymptomatic perivertebral cement leakage was seen in 88 patients (93.6%) and in 165 augmented vertebrae (73.3%). Cement leakage most often occurred in the perivertebral venous system. Clinically asymptomatic pulmonary cement embolism was found in 4 patients (4.1%). CONCLUSIONS Perivertebral cement leakage often occurs in pedicle screw augmentation, but in most cases, it is clinically asymptomatic. Cement augmentation should be performed under continuous fluoroscopy to avoid high-volume leakage. Alternative strategies, such as use of expandable screws, should be examined in more detail for patients at high risk of screw loosening.

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Section: Symptomatic Leakage Is Rarecontrasting

confidence: 54%

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Mueller

Baldauf

Marx

et al. 2016

SPI

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“…However, the effects are comparable with PV and no conclusive data exists to suggest the superiority of PK as far as pain relief is concerned [19,24,25]. PK would seem to be beneficial from a mechanical point of view in order to reduce the angle of kyphosis.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Vertebroplasty for Pathological Vertebral Compression Fractures Secondary to Multiple Myeloma – Medium-Term and Long-Term Assessment of Pain Relief and Quality of Life

Jurczyszyn

Banach²,

Godlewski³

et al. 2015

Adv Clin Exp Med

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Background. In patients with multiple myeloma (MM) there is a high risk of compression fractures of the spine. In the majority of cases, the method of treatment is percutaneous vertebroplasty (PV) or kyphoplasty (PK). The number of studies verifying their efficacy in MM is still relatively small. Objectives. The aim of this study has been to assess medium-and long-term pain relief as well as improvement in the quality of life (QL) after PV in MM cases. Material and Methods. There was a prospective group of 34 MM cases in which a total of 131 vertebral bodies were augmented by means of PV. It was possible to follow up 22 patients who agreed to take part in the assessment. Their level of daily activity and the level of pain were assessed using the Oswestry Back Pain scale and a visual analogue scale (VAS) before PV and at a later date (medium-term follow up was a mean of 10 months after the last operation). Five out of eight cases in which 4.5-5 years had elapsed since the first PV were tested again (long-term follow-up). Results. Relief of pain and improvement of QL, assessed a mean of 10 months after PV, proved to be statistically significant. On the average, pain decreased by 4.7 points as measured on the VAS scale and the average improvement in the QL measured on the Oswestry scale was 27.7%. There were no neurological or general complications. After 4.5-5 years, there has not been any significant change in the level of pain relief or the improvement in the QL in the 5 cases in which long-term assessment was possible. Conclusions. In MM cases, PV is a simple, effective and safe method for the treatment of vertebral infiltration and compression fractures, giving permanent long-term pain relief and concomitant improvement in the QL (Adv Clin Exp Med 2015, 24, 4, 651-656).

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“…A large series of 190 cases of kyphoplasty performed in myeloma patients reported a cement extravasation rate of 5%, with 1 patient requiring operative decompression. 10 This study reported a posterior defect in the vertebral body that had been missed because only a preoperative MRI scan was obtained, prompting the authors to recommend routine preoperative CT scanning for metastatic fractures. 10 Lastly, a study of 99 cases of kyphoplasty in metastatic cancer patients reported a 12% cement extravasation rate, with no delayed failures over a 2-year follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…10 This study reported a posterior defect in the vertebral body that had been missed because only a preoperative MRI scan was obtained, prompting the authors to recommend routine preoperative CT scanning for metastatic fractures. 10 Lastly, a study of 99 cases of kyphoplasty in metastatic cancer patients reported a 12% cement extravasation rate, with no delayed failures over a 2-year follow-up period. 11 This study, however, excluded patients with tumor involvement of the posterior cortex and spinal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Predictors of delayed failure of structural kyphoplasty for pathological compression fractures in cancer patients

Rajah¹,

Altshuler

Sadiq

et al. 2015

SPI

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OBJECT Pathological compression fractures in cancer patients cause significant pain and disability. Spinal metastases affect quality of life near the end of life and may require multiple procedures, including medical palliative care and open surgical decompression and fixation. An increasingly popular minimally invasive technique to treat metastatic instabilities is kyphoplasty. Even though it may alleviate pain due to pathological fractures, it may fail. However, delayed kyphoplasty failures with retropulsed cement and neural element compression have not been well reported. Such failures necessitate open surgical decompression and stabilization, and cement inserted during the kyphoplasty complicates salvage surgeries in patients with a disease-burdened spine. The authors sought to examine the incidence of delayed failure of structural kyphoplasty in a series of cement augmentations for pathological compression fractures. The goal was to identify risk predictors by analyzing patient and disease characteristics to reduce kyphoplasty failure and to prevent excessive surgical procedures at the end of life. METHODS The authors retrospectively reviewed the records of all patients with metastatic cancer from 2010 to 2013 who had undergone a procedure involving cement augmentation for a pathological compression fracture at their institution. The authors examined the characteristics of the patients, diseases, and radiographic fractures. RESULTS In total, 37 patients underwent cement augmentation in 75 spinal levels during 45 surgeries. Four patients had delayed structural kyphoplasty failure necessitating surgical decompression and fusion. The mean time to kyphoplasty failure was 2.88 ± 1.24 months. The mean loss of vertebral body height was 16% in the patients in whom kyphoplasty failed and 32% in patients in whom kyphoplasty did not fail. No posterior intraoperative cement extravasation was observed in the patients in whom kyphoplasty had failed. The mean spinal instability neoplastic score was 10.8 in the patients in whom kyphoplasty failed and 10.1 in those in whom kyphoplasty did not fail. Approximately 50% of the kyphoplasty failures occurred at junctional spinal levels. All the patients in whom kyphoplasty failed had fractures in 3 or more cortical walls before treatment, whereas 46% of patients in the nonfailure group had fractures with breaching of 3 or more walls. CONCLUSIONS Although rare, delayed failures of structural augmentation with cement during kyphoplasty do occur and can lead to additional surgeries. A possible predictive index may include wall integrity of the vertebral body, competency of the posterior tension band, and location of the kyphoplasty at a junctional spinal level. Additional studies are required to confirm these findings.

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Kyphoplasty for Patients With Multiple Myeloma Is a Safe Surgical Procedure: Results From a Large Patient Cohort

Cited by 30 publications

References 50 publications

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Percutaneous Vertebroplasty for Pathological Vertebral Compression Fractures Secondary to Multiple Myeloma – Medium-Term and Long-Term Assessment of Pain Relief and Quality of Life

Predictors of delayed failure of structural kyphoplasty for pathological compression fractures in cancer patients

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