80% of myeloma patients have lytic bone lesions and osteoporosis secondary to corticosteroid therapy with high rate of vertebral compression fractures (VCFs). The consequences include pain and spinal deformity. The treatment ideally should address both the fracture-related pain and associated spinal deformity. Kyphoplasty provides a new tool that may impact bone care entailing the insertion and expansion of an inflatable bone tamps (IBT) in a fractured vertebral body. Bone cement is then deposited into the cavity to correct the deformity and improvement in structural integrity of collapsed vertebra. Eighteen VCFs were treated during 11 balloon kyphoplasty procedures in 7 multiple myeloma patients. The clinical outcomes were assessed according to visual analogue scale with 0 representing no pain and 10 severe pain. Patients rated their pain before surgery, 1 week after surgery and at 1 year-postoperative period. Mean improvement in local sagittal alignment was 12.3°. All of the patients who had reached the 1-year postoperative period had reported a high reduction in pain. Treatment with chemotherapy and/or radiation therapy is very important in the control of bone disease. Patients treated with kyphoplasty in combination with pharmacologic therapy return to higher activity levels, leading to increased independence and quality of life.
Corticosteroid-induced osteoporosis is the most common cause of drug-related osteoporosis and appears frequently in the patients affected from rheumatoid arthritis with high rate of pathological vertebral compression fractures (VCFs). The consequences of VCFs include pain related to the fracture and spinal kyphosis. The aim of treatment of osteoporosis is to halt bone loss, to reduce pain and to prevent the occurrence of future fractures through osteoinduction. The treatment of osteoporotic VCFs ideally should address both the fracture-related pain and associated spinal deformity. Balloon kyphoplasty entails the insertion and expansion of an inflatable bone tamps (IBT) in a fractured vertebral body. Bone cement is then deposited into the cavity created by the IBT to reduce the kyphosis and repair the fracture. Twenty-nine corticosteroid-induced osteoporotic VCFs were treated during 21 balloon kyphoplasty procedures in 17 patients. Standing radiographs centered on the treated level/s obtained prekyphoplasty and postkyphoplasty were analysed for improvement in sagittal alignment using the Cobb technique. The clinical outcomes were assessed according to visual analogue scale with 0 representing no pain and 10 severe pain. Patients rated their pain before surgery, 1 week after surgery and at 1 year-postoperative period. Mean improvement in local sagittal alignment was 11.3° (range 0°–32°). All of the patients who had reached the 1-year postoperative period had reported a high reduction in pain, with 11 patients reporting no pain whatsoever. Corticosteroid-induced osteoporotic VCFs present a significant economic burden to society and result in severe clinical consequences leading to impaired function, reduced pulmonary function and overall increase in mortality. Traditional medical option including bed rest, bracing and analgesics have proven to be insufficient. Patients with rheumatoid arthritis treated with kyphoplasty in combination with pharmacologic therapy return to higher activity levels, leading to increased independence and quality of life.
Seven patients who had malignant proximal femoral tumours were selected for resection and limb salvage with a modular megaprosthesis. Histopathological diagnosis confirmed one solitary bone metastasis from renal cell carcinoma, one dedifferentiated chondrosarcoma, two primary non-Hodgkin lymphomas non-responsive to adjuvant chemo- and radiotherapy and three low-grade chondrosarcomas. The mean age at the time of surgery was 53.5 years. Post-operative survival averaged 54.5 months. The mean functional status score was satisfactory. There was no local tumour recurrence or dislocation of the prosthesis. There were one superficial wound infection and one post-surgical haematoma. Care must be taken in selecting patients to for resection of the proximal femur and implantation of modular megaprostheses. We reserve such treatment only for tumours that, because of the histopathological diagnosis and spread, chemotherapy or radiotherapy alone is not enough. Modular megaprosthesis is currently the method of choice in the treatment of malignant proximal femoral tumours. With this implant joint function can be restored after wide resection, too, offering a valid alternative to the bony massive allografts that are characterised by a high rate of complications and failure.
Pain and kyphosis in vertebral body compression fractures (VBCF) impair quality of life. Conservative treatment has been the proposed solution up to now. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body by a trans-pedicle approach. The purpose of IBT is to restore the original height of the vertebral body while creating a cavity that can be filled with highly viscous methylmethacrylate. We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of pain related to pathological vertebral body compression fractures resulting from osteoporotic collapse, multiple myeloma, primary malignant tumours (lymphoma) and metastatic cancer. Clinical results show immediate and maintained pain relief in all patients who received this treatment and a more rapid improvement in function. Pain relief may be related to spinal realignment by restoring the weight-bearing on the anterior column and to biological factors such as damage of pain-receptors due to the high temperature of cement polymerisation.
