Long-term follow-up and Treatment outcome of MM-associated spinal fracture by percutaneous vertebroplasty (PVP)  会议论文 期刊论文  

Background: One of the main features of multiple myeloma (MM) is bone damage and spine is commonly affected. Pathological fractures of vertebral body caused by MM normally involve multiple vertebral bodies and effective therapies are currently lacking.
Objective: The objective of this study was to evaluate the clinical efficacy and adverse reactions of percutaneous vertebroplasty (PVP) treatment for MM-associated spinal fracture.
Methods: A total of 76 patients with MM-associated spinal fracture (confirmed by osteostixis or pathological examination) were randomly divided into combined (PVP and chemotherapy) treatment group (n=38) and single chemotherapy group (n=38). For the combined treatment group, bone cement was injected into vertebral body via DSA guided-percutaneous puncture. After surgery, M2 scheme was used for chemotherapy. For the single chemotherapy group, only M2 scheme was performed. The height of the vertebral body was determined before and after treatment. A 5-year follow-up was conducted for all the patients. During the follow-up, score of bone pain, changes of spinal stability and adverse reactions were examined.
Results: Leakage of cement to the anterior or lateral side of the vertebral body occurred in 20 patients in the combined treatment group. However, symptoms associated with spinal cord or nerve root compression were not observed. After treatment, anterior and central line height of the vertebral bodies was increased. At the one year follow-up visits, PVP combined with chemotherapy achieved Complete Remission (CR) in 6 (15.8%) patients, Near Complete Remission (nCR) in 10 (26.30%) patients, Partial Remission (PR) in 9 (23.7%) patients, Minimal Response (MR) in 3 (7.9%) patients, No Change (NC) in 4 (10.5%) patients and Disease Progression (DP) in 5 (13.2) patients. Chemotherapy alone without PVP resulted in 3 CR (7.9%), 8 nCR (26.30%), 19 PR (77.5%), 4 MR (17.5%), 4 NC (17.5%), and 2 DP (5.0%). While the Overall Response Rate in the combined treatment group and the single chemotherapy group (65.8%.and 50.0%, respectively) was not significantly different after treatment, their Visual Analogue Pain Scales (3.01 +/- 0.62 and 5.97 +/- 0.40, respectively) and Karnofsky performance scores (KPS, 89.4 +/- 6.3 and 80.3 +/- 7.2, respectively) were significantly improved after treatment (P=0.032 and P=0.002, respectively). Patients in both groups had a 3 year and 5 year follow-up, and the Overall Response Rate between the two groups were significantly different (P=0.001).
Conclusion: PVP is a minimally invasive surgery for MM-associated pathologic fracture. PVP had the characteristics of minimal trauma, easy operation and less complication. PVP can achieve long-term analgesic effect and enhance the spinal stability.