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Vertebroplasty: Integral to Treating Back
Pain in Blood Marrow Cancer Patients
Reduced Pain and Improved Mobility Gained When
Part of Treatment Plan for Vertebral Compression
Fractures in Those With Multiple Myeloma
Eren Erdem, MD
Interventional Neuroradiologist
Division Director and Associate Professor
University of Arkansas for Medical Sciences
The minimally invasive, image-guided treatment
of vertebroplasty is an integral component to the
complicated treatment of multiple myeloma, an
incurable (yet treatable) cancer of the bone
marrow that causes destructive lesions in bones
and makes them more susceptible to fracture.
Vertebral compression fractures are very
common in patients with multiple myeloma
(up to 70 %) and cause severe pain and
debilitation.
Patients can experience compression of
abdominal contents, decrease in lung capacity,
depression, anorexia and reduced ability to
perform normal daily functions
By reducing pain and improving mobility,
vertebroplasty helps patients become better
equipped to continue with their rigorous
treatment for multiple myeloma
• Founded 1989, Bart Barlogie, MD, PhD
Epidemiology
• 10% hematologic malignancies, 1% all
• Incidence 3-4/105, 20,000/year US
• 100,000 US patients in treatment
• 3:2 Male to female ratio
• African-Americans increased risk
Multiple Myeloma
Uncontrolled overgrowth of plasma cells
• Bone marrow failure
Anemia
Immune dysfunction
• Monoclonal Protein Secretion
Renal Failure
• Increased osteoclast, decreased osteoblast activity
Bone destruction
Bone Destruction
Osteoclast & Osteblast
“Un-coupling”
SEM courtesy of Dr. Arnett, UCL
Secondary osteoporosis
Study Objective
• Distribution and Extent Vertebral Fractures
• Efficacy of Vertebral Augmentation
– Pain
– Analgesic Usage
– Disability
Material & Methods
• 792 consecutive MM patients
• January 2001 through May 2007
• Prospective, IRB-approved study
Results
n=792
n=440
n=352
mean age 61.6 yrs, SD 10.9
65.6 yrs, SD 13.0
p<0.001
Results
Results
Results
Results
Results
• Pain Assessment
n=520
p < 0.001
Results
Results
Vertebroplasty Procedure
• Under local and intravenous medication
• No surgical incision
• Needles are placed into the vertebral bone
precisely, under advanced live x-ray
• The cement is then injected very carefully to
stabilize the fracture and alleviate pain
• Most procedures are done outpatient and rarely
requires limited time in the hospital
• There’s no incision, so there’s less pain and less
recovery time, only a bandaid
• Less expensive than surgery
Multiple Myeloma can be very debilitating
one month later
Pre/Post treatment –Jan 2005
Improved
kyphosis
When there is no pressure on the spinal
cord even the worst fractures can be
treated with vertebroplasty
Retropulsion
Why not open surgery?
• Open surgery is the last resort for multiple
myeloma and other cancer patients with
metastasis to the vertebra
• Usually, the bones don’t have enough structure
to anchor instruments such as screws and plates
• Also, being sick with cancer, these are very
aggressive surgeries to handle for the patients
Failed back sugery
When there is aggressive tumor,
interventional radiologists would ablate
the tumor at the time of vertebroplasty, to
achieve local disease control as well
T 11 expansile lesion
RFA and Cement injection
5 days post RFA
When the patient has many fractures and
decompensated, aggressive but safe long
procedures can be performed
14 levels treated
only two procedures
Conclusion
Although there is multiple large series of the
procedure’s success in osteoporotic patients,
this is the first large series on a cancer
population of multiple myeloma
With increasing experience, interventional
radiologists can effectively treat the most
complex and difficult cases of compression
fractures throughout the spinal column with
vertebroplasty