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Percutaneous cementoplasty in the treatment of multiple myeloma bone diseases

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Author:
No author available
Journal Title:
China Clinical Practical Medicine
Issue:
4
DOI:
10.3760/cma.j.issn.1673-8799.2015.04.010
Key Word:
多发性骨髓瘤;骨病;骨水泥成形术;Multiple myeloma;Bone disease;Cementoplasty

Abstract´╝Ü Objective To investigate the indications, methods, efficacy of cementoplasty and the prognosis for bone disease in patients with multiple myeloma. Methods July 2005 to May 2014, 35 cases of bone disease in patients with multiple myeloma were treated with cementoplasty, 19 males and 16 females, aged from 49 to 78 years, mean 62 years, including thoracic vertebrae 85, lumbar vertebrae 34, sacral vertebrae 5, iliac 6 , sternum 3 . Every patient, 1-5 lesions were operated. In thoracic vertebra, cement was injected about 2~4ml, in lumbar vertebra, bone cement was injected about 2~6ml, sacral 2~4ml, sternum 3~5ml, ilium 2~4ml. For postoperative 1 day, 3 days,1 month and 3 month, VAS were analyzed. Results Pain relief was obtained in all cases in varying degrees postoperatively, including 28 cases of a severe pain alleviated by a mild pain, six cases of moderate pain relieve to mild pain, and one case with the severe pain was eased to moderate pain. The VAS score decreased from 8.6(5 ~ 10) preoperatively to 3.7(2~6) day 1, 3.2(1~5) day 3, 2.4(1~3) 1 month and 2.1(1~3) 3 month postoperatively. No serious surgical complications occur. All cases were followed up for 3 to 76 months after surgery, 33 cases received chemotherapy, one patient died of complications of chemotherapy 3 months postoperatively, 5 cases died of tumor progression in a year , 1 year survival rate was 65.7%, medium overall survival time is 29 months at last follow up.After vertebroplasty,no spinal cord compression occurs requiring underwent open surgery, but there are five cases operated with cementoplasty again due pathological vertebral fractures of other vertebrae, two cases obtained vertebroplasy the third time due to other vertebral fracture. Conclusion For myeloma patients, vertebroplasty can significantly relieve pain, prevent the aggravation of vertebral compression and spinal cord compression, there is significant pain relief for non- load-bearing parts of sternum and iliac wing with cementoplasty, improve quality of life, but the final prognosis depends on the initial severity at presentation, tumor progression rate and the effect of chemotherapy. Patients with renal failure and advanced age could not tolerate chemotherapy have poor prognosis.

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