Percutaneous vertebroplasty to treat painful myelomatous vertebral deposits—long-term efficacy outcomes

Abstract

Objectives. Developed for benign conditions including osteoporotic fractures and haemangiomas, vertebroplasty has since been employed in neoplastic lesions, including myeloma. Advances in myeloma treatments, yielding improved survival times, have led to an increasing need for effective therapies that improve quality of life. The first randomised trials of vertebroplasty to treat painful osteoporotic crush fractures, have cast doubt of its benefit over a placebo procedure, with a proposed rationale that fracture healing over time may account for the non-superiority results. However these findings cannot be extrapolated to myeloma, where the pathology is one of progressive bony destruction, coupled with a failure of new bone formation. Here, we present the outcome data for myeloma patients treated at our tertiary-referral centre over a 5yr period, focusing on both subjective and objective measures of efficacy and safety. Patients/Methods. Records were reviewed to extract pain-score, function and analgesia pre/post procedure. Where possible, patients were then contacted directly and asked to assess their benefit by grading change in pain-score, analgesia use and mobility. Performance status was assessed using the Eastern Cooperative Oncology Group (ECOG) scale.Results. Of 26 patients treated for painful, thoraco-lumbar lesions, 77% reported improved pain-score (P<0.003). Analgesia reduction, better mobility and improved performance-status were also seen. Conclusion. Our data support the consideration of vertebroplasty as a first-line treatment for painful, myelomatous vertebral disease. Prospective, randomised studies are now required to further define its role.Response to Reviewers: Please see the attached file for our response to the reviewers comments. Reviewers have now commented on your paper. You will see that they are advising that you revise your manuscript. If you are prepared to undertake the work required, I would be pleased to reconsider my decision.The reviewers' comments can be found at the end of this email or can be accessed by following the provided link.If you decide to revise the work, please submit a list of changes or a rebuttal against each point which is being raised when you submit the revised manuscript.Your revision is due by 10-07-2010.To submit a revision, go to http://aohe.edmgr.com/ and log in as an Author. You will see a menu item call Submission Needing Revision. You will find your submission record there. Percutaneous vertebroplasty would also be considered for patients not appropriate for surgery based on their performance status. This information has now beein included in the discussion as paragraph 5.>Because of the retrospective nature of this study, we are unable to provide accurate information on the number of patients who were offered vertebroplasty but declined the procedure. In answer to the reviewers enquiry, our lead myeloma haematology Consultant is able to provide an approximate estimate that 5% of patients offered vertebroplasty do accept and proceed to have the proced...

Bone Disease in Multiple Myeloma: Pathophysiology and Management

“…77% of these patients had pain reduction after procedure, 1/3 of these became opioids independent, and 80% had improvement in mobility. There were three patients who had small cement leaks at the time of procedure, symptoms were resolved within 24 hours and there was no cement or fat emboli, bleeding, or infections 94. These procedures are less invasive with excellent outcome in improvement of pain and mobility.…”

Application of percutaneous vertebroplasty in the treatment of multiple thoracic metastases

“…Since the destruction of metastatic tumors is mostly osteolytic, it often results in bone defects. The vertebral compression fracture occurs when the spine bears the body weight and consequently increases pain and even causes neurological symptoms (5,6,19). The injection of bone cement can strengthen the vertebral structure and restore the height, proof pressure and intensity of vertebral bodies.…”

“…Furthermore, the heat effectively inactivates the tumor cells and reduces the production of the mediators of inflammation and pain. The heat also prevents the growth of cancer cells and reduces its compression on the nerve endings (19). iii) The monomer toxicity of PMMA.…”

Pain in malignant hematology

“…For patients who have large osteolytic lesions in weight-bearing bones, the application of orthopedic devices and surgery procedures to achieve pain control and as a prophylaxis for impending fractures may be required. In recent years, some techniques of vertebral augmentation and bone repair, such as percutaneous cementoplasty, vertebroplasty and kyphoplasty, have been developed to repair spinal fractures and have been demonstrated to be optimal tools for disability rehabilitation and to provide pain relief in MM patients [19,72].…”