melphalan and Spinal-Fractures

The clinical presentation of AL amyloidosis is highly variable. In this series, we describe five cases of AL amyloidosis with vertebral compression fractures as initial presentation. All five patients had evidence of bone marrow replacement on magnetic resonance imaging and bone marrow biopsies demonstrating diffuse interstitial amyloid deposition. Hepatomegaly and elevated liver enzymes, consistent with liver involvement with amyloidosis, were also seen in each case. All five patients responded well to anti-plasma cell chemotherapy, with normalization of serum free light chain levels, reduction in alkaline phosphatase and improvement in pain and functional status. Although rare, AL amyloidosis should be considered in the differential diagnosis of selected patients with spontaneous vertebral compression fractures. Moreover, there seems to be an association of vertebral compression fractures with liver involvement in AL amyloidosis.

Topics: Alkaline Phosphatase; Amyloidosis; Antineoplastic Agents; Bone Marrow; Bortezomib; Dexamethasone; Diagnosis, Differential; Female; Fractures, Compression; gamma-Glutamyltransferase; Hematopoietic Stem Cell Transplantation; Hepatomegaly; Humans; Immunoglobulin Light Chains; Immunoglobulin Light-chain Amyloidosis; Liver; Magnetic Resonance Imaging; Male; Melphalan; Middle Aged; Plasma Cells; Spinal Fractures

Percutaneous vertebroplasty (PVP) of the axis is a challenging procedure which may be performed by a percutaneous or a transoral approach. There are few reports of PVP at the C2 level. We report a case of unstable C2 fracture treated with the percutaneous approach. The fracture was the first manifestation of multiple myeloma in a previously healthy 47-year-old woman. After local radiotherapy and chemotherapy, the fracture was still unstable and the patient had been continuously wearing a stiff cervical collar for 9 months. Complication-free PVP resulted in pain relief and stabilization and use of the cervical collar could be discontinued. At 18 months follow-up the patient remained free from pain, the fracture was stable and she had returned to work. The purpose of this article is to present the technical facts and to highlight the benefits and potential complications of the procedure. The technical characteristics of the procedure, the indication and results of the present case are discussed together with previously reported cases of PVP treatment at C2.

Topics: Axis, Cervical Vertebra; Bone Cements; Female; Fluoroscopy; Humans; Magnetic Resonance Imaging; Melphalan; Middle Aged; Monitoring, Intraoperative; Multiple Myeloma; Myeloablative Agonists; Neck Pain; Radiotherapy; Spinal Fractures; Spinal Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Vertebroplasty