Abstract
Introduction
Spinal involvement is a common presentation of multiple myeloma (MM); however, the cervical spine is the least common site of myelomatous involvement. Few studies evaluate the results of percutaneous vertebroplasty (PV) in the treatment of MM of the spine. The purpose of this series is to report on the use of PV in the treatment of MM of the cervical spine and to review the literature.
Materials and methods
From January 1994 to October 2007, four patients (three men and one woman; mean age, 45 years) who underwent five PV for painful MM in the cervical spine were retrospectively reviewed. The pain was estimated by the patient on a verbal analogic scale. Clinical follow-up was available for all patients (mean, 27.5 months; range, 1–96 months).
Results
The mean volume of cement injected per vertebral body was 2.3 ± 0.8 mL (range, 1.0–4.0 mL) with a mean vertebral filling of 55.0 ± 12.0% (range, 40.0–75.0%). Analgesic efficacy was achieved in all patients. One patient had a spinal instability due to a progression of spinal deformity noted on follow-up radiographs, without clinical symptoms. Cement leakage was detected in three (60%) of the five treated vertebrae. There was no clinical complication.
Conclusions
The present series suggests that PV for MM of the cervical spine is safe and effective for pain control; nonetheless, the detrimental impact of the disease on bone quality should prompt close radiological follow-up after PV owing to the risk of spinal instability.
Similar content being viewed by others
References
Mundy GR (1998) Myeloma bone disease. Eur J Cancer 34:246–251
Cotten A, Boutry N, Cortet B (2002) Multiple myeloma. In: Mathis JM, Deramond H, Belkoff SM (eds) Percutaneous vertebroplasty. Springer, New York, pp 134–137
Barlogie B, Shaughnessy J, Tricot G et al (2004) Treatment of multiple myeloma. Blood 103:20–32
Yeh HS, Berenson JR (2006) Treatment for myeloma bone disease. Clin Cancer Res 12:6279–6284
Lecouvet FE, Vande Berg BC, Maldague BE (1997) Vertebral compression fractures in multiple myeloma. Part I. Distribution and appearance at MR imaging. Radiology 204:195–199
Chiras J, Depriester C, Weill A et al (1997) Percutaneous vertebral surgery. Technics and indications. J Neuroradiol 24:45–59
Deramond H, Depriester C, Galibert P et al (1998) Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 36:533–546
Ramos L, de Las Heras JA, Sánchez S et al (2006) Medium-term results of percutaneous vertebroplasty in multiple myeloma. Eur J Haematol 77:7–13
Diamond TH, Hartwell T, Clarke W et al (2004) Percutaneous vertebroplasty for acute vertebral body fracture and deformity in multiple myeloma: a short report. Br J Haematol 124:485–487
McDonald RJ, Trout AT, Gray LA et al (2008) Vertebroplasty in multiple myeloma: outcomes in a large patient series. AJNR Am J Neuroradiol 29:642–648
Pflugmacher R, Schleicher P, Schröder RJ et al (2006) Maintained pain reduction in five patients with multiple myeloma 12 months after treatment of the involved cervical vertebrae with vertebroplasty. Acta Radiol 47:823–829
Jantunen E, Laakso M (1996) Biophosphonates in multiple myeloma: current status; future perspectives. Br J Haematol 93:501–506
Angtuaco EJ, Fassas AB, Walker R et al (2004) Multiple myeloma: clinical review and diagnostic imaging. Radiology 231:11–23
Jonsson B, Jonsson H Jr, Karlstrom G et al (1994) Surgery of cervical spine metastases: a retrospective study. Eur Spine J 3:76–83
Rao G, Ha CS, Chakrabarti I et al (2006) Multiple myeloma of the cervical spine: treatment strategies for pain and spinal instability. J Neurosurg Spine 5:140–145
Lecouvet F, Richard F, Vande BB et al (1997) Longterm effects of localized spinal radiation therapy on vertebral fractures and focal lesions appearance in patients with multiple myeloma. Br J Haematol 96:743–745
Jonsson B, Sjostrom L, Jonsson H Jr et al (1992) Surgery for multiple myeloma of the spine. A retrospective analysis of 12 patients. Acta Orthop Scand 63:192–194
Chataigner H, Onimus M, Polette A (1998) Surgical treatment of myeloma localized in the spine. Rev Chir Orthop Reparatrice Appar Mot 84:311–318
Wegener B, Muller PE, Jansson V et al (2004) Cervical spine metastasis of multiple myeloma: a case report with 16 years of follow-up. Spine 29:E368–E372
Durr HR, Wegener B, Krodel A et al (2002) Multiple myeloma: surgery of the spine: retrospective analysis of 27 patients. Spine 27:320–326
Ploeg WT, Veldhuizen AG, The B et al (2006) Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine J 15:1749–1758
Yang X, Mi S, Mahadevia AA et al (2008) Pain reduction in osteoporotic patients with vertebral pain without measurable compression. Neuroradiology 50:153–159
Evans AJ, Jensen ME, Kip KE et al (2003) Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 226:366–372
Hodler J, Peck D, Gilula LA (2003) Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology 227:662–668
Feydy A, Cognard C, Miaux Y et al (1996) Acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas: report of 2 cases. Neuroradiology 38:389–391
Weill A, Chiras J, Simon JM et al (1996) Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology 199:241–247
Cotten A, Dewatre F, Cortet B et al (1996) Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 200:525–530
Calmels V, Vallée JN, Rose M et al (2007) Osteoblastic and mixed spinal metastases: evaluation of the analgesic efficacy of percutaneous vertebroplasty. AJNR Am J Neuroradiol 28:570–574
Mont’Alverne F, Vallee JN, Cormier E et al (2005) Percutaneous vertebroplasty for metastatic involvement of the axis. AJNR Am J Neuroradiol 26:1641–1645
Pilitsis JG, Rengachary SS (2001) The role of vertebroplasty in metastatic spinal disease. Neurosurg Focus 11:1–4
Barragán-Campos HM, Vallée JN, Lo D et al (2006) Percutaneous vertebroplasty for spinal metastases: complications. Radiology 238:354–362
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mont’Alverne, F., Vallée, JN., Guillevin, R. et al. Percutaneous vertebroplasty for multiple myeloma of the cervical spine. Neuroradiology 51, 237–242 (2009). https://doi.org/10.1007/s00234-008-0484-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-008-0484-5