Myeloma and multiple myeloma most commonly presents as unexplained back pain,
where further blood tests and diagnostic imaging confirms myeloma with vertebral fractures. If their pain does not respond to simple analgesia there are at present two clinical pathways to treat these patients. Percutaneous cement augmentation of the spine has been used since the early 1990s to treat patients with myeloma induced vertebral fractures but the more conventional practice has been to refer them for external beam radiotherapy. More centres are using percutaneous cement augmentation...
Methods and Materials
We are planning a prospective study to randomise patients with back pain associated with multiple myeloma comparing treatment with radiotherapy and cement augmentation. To determine the efficacy of vertebroplasty we undertook a retrospective review of patients with myeloma who we have treated with cement augmentation betweewn 2006 and 2011.
A VAS pain score and Roland Morris Disability score was taken before treatment and then at one month after treatment.
Some patients treated from 2009 onwards were offered a facet joint infiltration prior to treatment with...
Radiotherapy – 16/38 patients had undergone radiotherapy without success prior to cement augmentation.
Before 2009 of 26 procedures
2 died before f/u
4 incomplete data
10 unsuccessful with scores
After 2009 of 27 patients 7 had experienced failure of facet joint injections,
the remainder were not offered this procedure due to instability of fractures or previous successful vertebroplasty.
Of the 27 cement augmentations undertaken.
13 were successful
9 were unsuccessful
4 incomplete data
1 died before follow up
43.4% of cement...
Patients with pain associated with vertebral compression fractures in myeloma may be treated by radiotherapy or vertebral cement augmentation.
Some will respond to facet joint infiltration probably as they have an element of pain resulting from secondary disturbance of sagittal balance.
We anticipate successful outcome in around 43% of cases.
This is less effective than comparable series using the technique for osteoporotic fractures.
We are planning a prospective study comparing cement augmentation with radiotherapy.
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David Wilson is a musculoskeletal interventional radiologist in Oxford UK.
He is co-author of the NEJM paper describing the INVEST study and has over 22 years of cement augmentation experience.
Sara Owen is a medical ethicist and has performed data collection for three cement augmentation studies.