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Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up.
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1996
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The study aimed to assess whether the extent of vertebral lesion filling and methyl methacrylate leakage influence clinical outcomes after percutaneous vertebroplasty. Forty vertebroplasties were performed on 37 patients with metastatic or myeloma lesions, and CT scans 1–8 h post‑injection quantified cement filling and leakage into epidural, foraminal, discal, venous, and paravertebral spaces. Pain relief was achieved in 97 % of patients and persisted regardless of filling percentage, with most leaks being clinically insignificant; only two foraminal leaks caused nerve compression requiring surgery and one paravertebral leak caused transient femoral neuropathy.
To determine whether the percentage of vertebral lesion filling and the leakage of methyl methacrylate have any clinical significance at follow-up.Forty percutaneous vertebroplasties were performed for metastases (30 cases) and myeloma (10 cases) in 37 patients. A computed tomographic scan was obtained 1-8 hours after methyl methacrylate injection and was used to assess the percentage of lesion filling by methyl methacrylate and the leakage of methyl methacrylate into the epidural tissues, neural foramina, intervertebral disks, venous plexus, and paravertebral tissue. The results were correlated with those obtained at clinical follow-up.Partial or complete pain relief was sustained in 36 of 37 patients. Pain relief was not proportional to the percentage of lesion filling. Clinical improvement was maintained in most patients. The 15 epidural leaks, eight intradiskal leaks, and two venous leaks of methyl methacrylate had no clinical importance. Two of eight foraminal leaks produced nerve root compression that required decompressive surgery. One of 21 paravertebral leaks produced transitory femoral neuropathy.Pain relief can occur despite insufficient lesion filling. In most patients, intradiskal and paravertebral leaks of cement had no clinical importance.