PERCUTANEOUS VERTEBROPLASTY IN PATIENTS WITH OSTEOLYTIC METASTASES ORMULTIPLE-MYELOMA

Osteolytic metastases and spinal myeloma lesions are difficult to trea t because they denote disseminated malignant disease, The pain-relievi ng and other effects of radiation therapy are delayed, We evaluated sh ort- and medium-term outcomes of vertebroplasty in this indication, in patients with severe:or excruciatingly severe pain (McGill-Melsack sc ore 4 or 5) unresponsive to narcotics, Patients and methods: forty ver tebras were treated in 37 patients including 29 with bone metastases a nd eight with multiple myeloma, Mean age was 58 years (range 36-83), T he spinal segment involved was the cervical spine in five cases, the t horacic spine in 12 and the Lumbar spine in 23., Vertebroplasty was do ne under fluoroscopy guidance after premedication and local anesthesia , Results: thirty-six patients (97.3%) reported a decrease in their pa in 48 hours after the procedure; five of these patients (13.5%) were c ompletely free of pain, 20 (55%) were significantly improved and 11 (3 0%) were moderately improved, One patient failed to respond, The clini cal results were not correlated to the extent of vertebral body fillin g, Beneficial effects were increased or unchanged in 100% of cases aft er one month, 88.9% after three months and 75% after six months, Leaka ge of the cement outside the vertebral body occurred in 29 cases (72.5 %), usually into the paraspinal soft tissues (n-21, 52.5%), Leakage wa s usually clinically silent and only two patients developed severe ner ve root pain due to leakage into a neural foramen, with in both instan ces a favorable outcome after surgery. Conclusion vertebroplasty is si mple and effective for the treatment of osteolytic metastases and mult iple myeloma lesions, but should be performed only in centers with neu rosurgical and/or orthopedic surgery units because of the possibility of severe complications.