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Bone marrow washout for multilevel vertebroplasty in multiple myeloma spinal involvement. Technical note.

  • Oded Hershkovich
  • Corrado Lucantoni
  • Saurabh Kapoor
  • Bronek Boszczyk
Ideas and Technical Innovations

Abstract

Introduction

Vertebral involvement is found in a high percentage of multiple myeloma (MM) patients, often requiring multilevel surgical treatment to reduce pain and disability and to receive prompt access to oncological care. We describe the clinical use of washout technique for multilevel vertebroplasty in MM patients with diffuse spinal involvement. The aim of this technique is to reduce the risk of pulmonary fat embolism after cement injection and possibly to increment the amount of cement and treated levels in one surgical stage.

Methods

Three patients were treated with the washout technique prior to multilevel vertebroplasty for thoracolumbar diffuse spinal involvement in multiple myeloma. We describe the surgical technique and review the pertinent literature.

Results

The technique is clinically safe and effective in reducing pain, without significant complications. Two six-level vertebroplasties were performed in one case, allowing a larger amount of cement injected and a prompt start of the oncological treatment.

Conclusions

Multilevel vertebroplasty in MM patients with diffuse spinal involvement carries the advantages of reducing pain, avoid repeated surgeries and faster return to oncological regimen. Cardiovascular complications, including pulmonary embolism, are rare but can have fatal consequences. It is mainly due to bone marrow mobilization during cement injection and the risk increases with the amount of cement injected and the number of treated levels. Despite multilevel treatment at the same stage, we did not observe any significant complication in our series. Further studies are needed to confirm the preliminary results of this technique.

Graphical abstract

These slides can be retrieved under electronic supplementary material.

Keywords

Multiple myeloma Vertebroplasty Fat pulmonary embolism Vertebral washout Lavage 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Supplementary material

586_2018_5804_MOESM1_ESM.pptx (585 kb)
Supplementary material 1 (PPTX 585 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Spinal Studies and SurgeryQueen’s Medical CentreNottinghamUK

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