Document Detail


Percutaneous vertebroplasty for malignant compression fractures with epidural involvement.
MedLine Citation:
PMID:  15273339     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To evaluate safety and effectiveness of performance of percutaneous vertebroplasty (PVP) in patients with malignant compression fractures and involvement of the epidural space. MATERIALS AND METHODS: PVP was performed in 50 patients with metastatic disease or multiple myeloma between June 1998 and April 2002. Twenty-five women (mean age, 62.3 years; range, 38-85 years) and 25 men (mean age, 63.1 years; range, 37-92 years) were included. Cases were retrospectively reviewed. Patients who had undergone cross-sectional imaging were classified into three groups. First group had no epidural involvement; second group, mild epidural involvement without contact with spinal cord or nerve roots; third group, moderate involvement and contact with spinal cord or nerve roots. Procedural safety was evaluated with review of all post-PVP complications and their treatment. Effectiveness was evaluated with follow-up phone calls for assessment of change in pain level and activity after PVP. Follow-up calls were performed at 1 day; 2 weeks; 1, 3, and 6 months; and 1 and 2 years. Differences between groups were assessed with singly ordered Kruskal-Wallis test. RESULTS: Fourteen patients were classified in the first group, 18 in the second, and 18 in the third. There were no significant differences in pain or mobility outcomes among groups. At the last follow-up call, 41 (82%) of 50 patients reported improvement in pre-PVP pain. Six (12%) reported no change, and three (6%) reported increased pain. After PVP in 26 (52%) patients, there was a period of increased mobility; in 19 (38%), no improvement in mobility occurred; and in five (10%), decreased mobility was reported. Complications included acute increased pain or new areas of pain in seven (14%) patients. None of these required surgery; four were treated with nerve root block; two, with central epidural injection; and one, with overnight intravenous steroids. CONCLUSION: PVP can be performed safely and effectively with conscious sedation in patients with malignant compression fractures and epidural involvement.
Authors:
Joshua S Shimony; Louis A Gilula; Andrew J Zeller; Daniel B Brown
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Publication Detail:
Type:  Journal Article     Date:  2004-07-23
Journal Detail:
Title:  Radiology     Volume:  232     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-08-30     Completed Date:  2004-09-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  846-53     Citation Subset:  AIM; IM    
Copyright Information:
Copyright RSNA, 2004
Affiliation:
Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110, USA. shimonyj@mir.wustl.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Epidural Neoplasms / complications
Female
Fractures, Spontaneous / etiology*,  surgery*
Humans
Male
Middle Aged
Neoplasms, Multiple Primary / complications
Orthopedic Procedures / methods
Retrospective Studies
Spinal Fractures / etiology*,  surgery*
Spinal Neoplasms / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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