eren erdem, md interventional neuroradiologist division director and associate professor
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Reduced Pain and Improved Mobility Gained When Reduced Pain and Improved Mobility Gained When Part of Treatment Plan for Vertebral Compression Part of Treatment Plan for Vertebral Compression
Fractures in Those With Fractures in Those With Multiple MyelomaMultiple Myeloma
Eren Erdem, MDInterventional Neuroradiologist
Division Director and Associate Professor
University of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences
Vertebroplasty: Integral to Treating Back Vertebroplasty: Integral to Treating Back Pain in Blood Marrow Cancer PatientsPain in Blood Marrow Cancer Patients
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, PhDFounded 1989, Bart Barlogie, MD, PhD
EpidemiologyEpidemiology
• 10% hematologic malignancies, 1% all10% hematologic malignancies, 1% all
• Incidence 3-4/10Incidence 3-4/1055, 20,000/year US, 20,000/year US
• 100,000 US patients in treatment100,000 US patients in treatment
• 3:2 Male to female ratio3:2 Male to female ratio
• African-Americans increased riskAfrican-Americans increased risk
Multiple MyelomaMultiple Myeloma
Uncontrolled overgrowth of plasma cellsUncontrolled overgrowth of plasma cells
• Bone marrow failureBone marrow failure AnemiaAnemia
Immune dysfunctionImmune dysfunction
• Monoclonal Protein SecretionMonoclonal Protein Secretion Renal FailureRenal Failure
• Increased osteoclast, decreased osteoblast activityIncreased osteoclast, decreased osteoblast activity Bone destructionBone destruction
Osteoclast & Osteblast Osteoclast & Osteblast “Un-coupling”“Un-coupling”
Bone DestructionBone Destruction
SEM courtesy of Dr. Arnett, UCL
Secondary osteoporosisSecondary osteoporosis
Study ObjectiveStudy Objective
• Distribution and Extent Vertebral FracturesDistribution and Extent Vertebral Fractures
• Efficacy of Vertebral AugmentationEfficacy of Vertebral Augmentation– PainPain– Analgesic UsageAnalgesic Usage– DisabilityDisability
Material & MethodsMaterial & Methods
• 792 consecutive MM patients792 consecutive MM patients
• January 2001 through May 2007January 2001 through May 2007
• Prospective, IRB-approved studyProspective, IRB-approved study
ResultsResults
n=792
n=440 mean age 61.6 yrs, SD 10.9 p<0.001n=352 65.6 yrs, SD 13.0
ResultsResults
ResultsResults
ResultsResults
ResultsResults
ResultsResults• Pain AssessmentPain Assessment
p < 0.001
n=520
ResultsResults
ResultsResults
Vertebroplasty ProcedureVertebroplasty 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 debilitatingMultiple Myeloma can be very debilitating
one month laterone month later
Pre/Post treatment –Jan 2005Pre/Post treatment –Jan 2005
Improved kyphosis
When there is no pressure on the spinal When there is no pressure on the spinal cord even the worst fractures can be cord even the worst fractures can be
treated with vertebroplasty treated with vertebroplasty
Retropulsion Retropulsion
Why not open surgery?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 sugeryFailed back sugery
When there is aggressive tumor, When there is aggressive tumor, interventional radiologists would ablate interventional radiologists would ablate
the tumor at the time of vertebroplasty, to the tumor at the time of vertebroplasty, to achieve local disease control as well achieve local disease control as well
T 11 expansile lesionT 11 expansile lesion
RFA and Cement injectionRFA and Cement injection
5 days post RFA5 days post RFA
When the patient has many fractures and When the patient has many fractures and decompensated, aggressive but safe long decompensated, aggressive but safe long
procedures can be performedprocedures can be performed
14 levels treated
only two procedures
ConclusionConclusion
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