Risk of New Fractures in Vertebroplasty for Multiple Myeloma. A Retrospective Study

Abstract

Objective Vertebroplasty is a percutaneous minimally invasive procedure indicated for vertebral collapse pain treatment. Among the known complications of the procedure is the augmented risk of new vertebral fractures. There are no specific studies in this patient population describing the risk of new vertebral fractures after vertebroplasty. This study analyzed risk factors associated with new vertebral fractures after vertebroplasty in patients with multiple myeloma. Methods Observational retrospective study in patients with multiple myeloma. The data collection took place from January 1, 2010, to December 30, 2017, at the National Cancer Institute. Clinical data and procedural variables such as cement volume, cement leaks, fracture level, number of treated vertebrae, pedicular disease, and cement distribution pattern, with two years follow-up, were analyzed with the Wilcoxon test, and a logistic regression model was used to identify risk factors related to new vertebral fractures. A confidence interval of 95% was used for analysis. Results At one-year follow-up, 30% of fractures were reported after vertebroplasty, most of them at low thoracic and lumbar level (50% adjacent level). Vertebroplasty was most commonly performed at the thoracolumbar and lumbar area. We demonstrated a 70.7% median numerical rating scale reduction at one-year follow-up; a significant decrease in opioid consumption occurred only during the first month. Conclusions Pedicle involvement, disc leakage, cement volume, thoracolumbar and lumbar level, and number of treated vertebrae by intervention are important risk factors when performing vertebroplasty. Prospective randomized studies are needed to evaluate these factors in this specific population.

Clinical efficacy and biomechanical analysis of a novel hollow pedicle screw combined with kyphoplasty for the treatment of Kümmell disease

“…However, polymethylmethacrylate (PMMA) bone cement lacked osseointegration ability, which could easily lead to loosening and displacement, causing postoperative adjacent vertebra fractures and recompression fractures, thereby requiring further surgical intervention [7][8][9]. A retrospective study found that the incidence of cement displacement was about 18.20%, and the time of post-operative cement displacement ranged from 1.8 to 38.2 months [10].…”

Modified poly(methyl methacrylate) bone cement in the treatment of Kümmell disease

“…However, PMMA bone cement lacks osseointegration ability and has a higher elastic modulus, which could easily lead to loosening and displacement of bone cement, cause postoperative adjacent vertebra fractures and re-compression fractures, thereby requiring further surgical intervention [ 7 , 8 ]. The incidence of new fractures has been reported to be 5.0–22.0% and 17.2–52.0% in 1 and 4 years postoperatively, respectively [ 9 , 10 ].…”