Keywords:
Patterns of Care, Metabolic disorders, Oedema, Vertebroplasty, Ethics, Audit and standards, MR, Fluoroscopy, CT, Musculoskeletal spine, Interventional non-vascular, Haematologic
Authors:
D. J. Wilson, S. Owen; Oxford/UK
DOI:
10.1594/ecr2013/C-2636
Purpose
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 but there are no published studies randomizing these patients to either clinical pathway to confirm which is the most effective treatment.
The efficacy of both methods is uncertain,
annectodal evidence suggests that radiotherapy is helpful in around 60% of cases whilst cement augmentation is thought to be effective in around 75% to 80% of cases.
These figures are not supported by randomised studies.