Christoph Gregor Trumm MD, Presenter: Nothing to Disclose

Robert Stahl MD, Abstract Co-Author: Nothing to Disclose

Thomas Helmberger MD, Abstract Co-Author: Nothing to Disclose

Tobias Franz Jakobs MD, Abstract Co-Author: Speaker, Sirtex Medical Ltd, Europe

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Ralf Thorsten Hoffmann MD, Abstract Co-Author: Speaker, Sirtex Medical Ltd

This retrospective study aimed to assess the results of CT-fluoroscopically guided vertebroplasty in patients with multiple myeloma, focusing on the frequency and clinical impact of polymethylmetacrylate (PMMA) leaks.

From 12/2001 to 08/2008 39 patients (17f, 22m; 65±7y) with multiple myeloma suffering from painful osteolyses and compression fractures underwent vertebroplasty. 67 vertebrae were treated in 44 sessions under CT-fluoroscopy (single slice, 4-, 16-row MDCT). In the planning CT scan osteolytic destruction (0/≤25/≤50/≤75/≤100%) was assessed regarding the vertebral cross-sectional area, the cortical border of the spinal canal and outer vertebral circumference. The postinterventional CT was used to detect local PMMA leaks (intradiscal, intraspinal, paravertebral, intercostovertebral/posterolateral, vascular). Patient charts were reviewed respecting adverse events. Clinical outcome (VAS) was assessed 24 hours before and after, and 6 months after vertebroplasty.

37.3%, 12.0% and 6.0% of 67 vertebrae showed an osteolytic involvement of the cross-sectional area, spinal canal and outer vertebral cortex >50%, respectively. Leakage distribution in 34/67 affected vertebrae (50.8% leakage rate) was 21.6% intradiscal, 35.1% intraspinal, 43.3% paravertebral and 0% intercostovertebral-posterolateral. Ratio of leaks into basivertebral/segmental veins was 16.2%/40.5%. No major complications (radiculopathy, pulmonary embolism) occurred. Mean VAS score decreased significantly (p<0.05) from 6.4 (24h before vertebroplasty) to 3.9/3.2 (24h/9.0 months after vertebroplasty), respectively.

Vertebroplasty in multiple myeloma of the spine can be performed safely under CT-fluoroscopy even with substantial destruction of the vertebral cross-sectional area or cortical bone. Our series showed a high clinical success rate while cortical and vascular PMMA leaks had no impact on patients´ well-being.

With the direct visualization of osteolyses and vascular leaks during cement injection CT-Fluoroscopy contributes to avoid PMMA-related local and systemic complications like PE in MM patients.

Trumm, C, Stahl, R, Helmberger, T, Jakobs, T, Reiser, M, Hoffmann, R, CT Fluoroscopy-guided Percutaneous Vertebroplasty in Patients with Multiple Myeloma: Results in 44 Sessions with 67 Vertebrae Treated  .  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8007823.html