Kyphoplasty for Patients With Multiple Myeloma is a Safe Surgical Procedure: Results From a Large Patient Cohort

Franz-Xaver Huber; Nicholas McArthur; Michael Tanner; Bernd Gritzbach; Oliver Schoierer; Wolfram Rothfischer; Gerhard Krohmer; Erich Lessl; Martin Baier; Peter Jürgen Meeder; Christian Kasperk

Disclosures

Clin Lymphoma Myeloma. 2009;9(5):375-380. 

In This Article

Patients and Methods

Patient Cohort

Seventy-six patients with a total of 190 vertebral fractures or osteolyses between December 2001 and December 2008 were treated with kyphoplasty in our department. Before the indication for the procedure was set, all of our patients were initially assessed by an interdisciplinary kyphoplasty colloquium, composed of consultants in the fields of traumatology, radiology, endocrinology, and oncology. Our indication setting for kyphoplasty was applied to painful osteolytic or fractured vertebrae or even beginning vertebral instability caused by osteolyses of MM.

Contraindications included patients with instability of the posterior wall (Figures 1A and 1B) and/or pedicles, an infection of the fractured vertebra, a severe hemorrhagic diathesis, known allergies to the cements, pregnancy, American Society of Anesthesiologists score of 4, and a preoperative pathologic neurologic status resulting from the MM spine lesions.

Figure 1.

An Osteolysis of the Posterior Wall as Seen Here in the Axial and Sagittal Planes Is an Absolute Contraindication for Kyphoplasty in Patients With Multiple Myeloma

Operative Technique

Following general anesthesia, the patient was placed in prone position on a carbon fiber radiolucent C-arm table. Extra padding was placed beneath the head, chest, pelvis, and extremities. The procedure was performed under a single shot of antibiotics of cefuroxime 1.5 g (Fresenius Kabi Deutschland GmbH; Bad Homburg, Germany). The position of the fractured vertebrae was then localized with the help of fluoroscopy. The skin was then disinfected, and all of the patient's skin area except the site of incision was covered with sterile drapes. The pedicles of the fractured vertebrae were then displayed under fluoroscopy using the C-arm. Kyphoplasty was performed according to the procedure described by Noldge et al.[9] KyphX® HV-R™ (High-Viscosity Radiopaque) from Kyphon (Kyphon Inc.; Sunnyvale, CA) was used as the bone cement. We performed kyphoplasty on a maximum of 5 vertebral bodies in 1 surgical sitting on each patient. Two years ago, we began using a C-arm with 3-dimensional (3-D) imaging (ARCADIS Orbic 3D; Siemens AG; Munich, Germany) on a standard basis in order to have the option of performing a 3-D scan in case of cement extravasation.

Postoperative Management

During the first 24 hours following kyphoplasty blood supply, motor and sensory functions of the extremities were monitored at close intervals. Besides the conventional radiographs in 2 planes, a computed tomography (CT) scan of the area of interest was also used to establish any cement leakage (Figures 2A, 2B, 2C, 2D, and 2E). After the first postoperative day, patients were mobilized in the ward under the supervision of physiotherapists. The aftercare followed in cooperation with a consultant osteologist and oncologist, mainly focused on treating the underlying disease, eg, osteoporosis or MM. Clinical and radiologic checkups were conducted at 1, 3, 6, and 12 months postoperatively. Checkups then follow once yearly, or sooner if the patient faces any problems.

Figures 2A&2B.

Conventional Radiographs Following Kyphoplasty of T9

Figures 2C&2D.

Postoperative Computed Tomography Image Reconstructions in Sagittal and Coronal Planes

Figure 2E.

Postoperative Computed Tomography Reconstructions in the Transversal Plane

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