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Multiple myeloma
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Patients being treated for multiple myeloma may suffer acute back pain secondary to vertebral body collapse even after effective chemotherapy. This is due to resolution of the tumour mass that was supporting the bony cortex. In one small study, new vertebral compression fractures were discovered on post-treatment MR scans in 50% of patients with multiple myeloma in remission (142). In another study, 131 vertebral compression fractures appeared in 37 patients with multiple myeloma after the onset of therapy (143). Conversely, progression of disease may also be responsible for a new compression fracture and MRI may be useful in differentiating between these two clinical settings. It has been shown that patients with either normal marrow appearance or less than 10 focal lesions on pre-treatment MRI had significantly longer fracture-free survival than patients with more than 10 focal lesions or with diffuse patterns (143). In one study, the combination of an SUVmax >3.5 and diffuse or multifocal vertebral body involvement at MRI was found to indicate impending pathological fracture (144).
Thoracolumbar and sacral fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
S. Rajasekaran, Rishi Mugesh Kanna, Ajoy Prasad Shetty, Anupama Mahesh
Bone density studies are useful for evaluating the severity of osteoporosis and in advising patients of the likelihood of subsequent fractures. A T score of –2.5 indicates severe osteoporosis and warrants appropriate treatment as explained below. It is important to recognize that bone mineral density measured at the lumbar spine in those over 70 years of age may be falsely elevated due to end plate sclerosis, aortic calcification or spondyloarthropathy. In general, a low bone mineral density (T score <–1) is an independent predictor of fractures and hence it is recommended that all women aged 65 years or older, regardless of additional risk factors, have a bone mineral density measurement. A nuclear medicine bone scan is useful when surveying the entire skeleton for osteoporotic fractures, especially when symptoms are atypical. It is particularly helpful in diagnosing sacral insufficiency fractures, which are common in osteoporosis but difficult to visualize on radiographs. Bone scans also can differentiate between an acute or healed compression fracture because new fractures will appear as ‘hot’ spots.
Pathological fractures
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
James Wong, Harry Krishnan, Tim Briggs, Will Aston
The spine is the most common site of bony metastasis, with the vertebral body more commonly affected than the posterior elements. Lesions are often very painful and may manifest with a pathological compression fracture.
Rapid progression of acute cervical syringomyelia: A case report of delayed complications following spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2022
Chenghua Yuan, Jian Guan, Fengzeng Jian
Dyspnea, dysphagia, and circulatory disturbance symptoms disappeared after the operation; however, numbness persisted while pain and the sensation of stepping on cotton were slightly alleviated. The CSF sample revealed acid-fast bacilli negative findings and there was no bacterial growth in the CSF culture for 2 days. MRI performed 1 month (Figure 3A), 3 months (Figure 3(B–D)), and 6 months (Figure 3(E–G)) post-operatively revealed syringobulbia and syringomyelia resolution without posterior cranial neurological symptom recurrence, though pain, numbness, and the sensation of stepping on cotton persisted. Then we recommend a second operation for restoration at the level of the traumatic L2 compression fracture. The patient had not yet consented to a second operation at the time of publication.
Re-irradiation for painful bone metastases using stereotactic body radiotherapy
Published in Acta Oncologica, 2018
Hiroaki Ogawa, Kei Ito, Takuya Shimizuguchi, Tomohisa Furuya, Keiji Nihei, Katsuyuki Karasawa
Median follow-up time after SBRT was 10 months (range, 1–37 months). Figure 1 shows the proportion of patients with worst NRPS in each period. Thirty-four patients (52%) achieved CR. Overall, 57 of the 66 patients (86%) achieved pain response after SBRT. Pain progression was observed in six patients (9%). Pain progression caused by vertebral compression fracture (VCF) was observed in one case. Mean NRPSs at baseline, 1–3 months, 4–6 months, 7–9 months, and 10–12 months after SBRT were 5.7, 2.1, 2.2, 2.3, and 1.6, respectively. We noted significant reductions in mean NRPS between baseline and 1–3 months (p < .0001), 4–6 months (p < .0001), 7–9 months (p = .0005) and 10–12 months (p = .0002). We also noted a significant decrease in the percentage of patients with severe NRPS (≥7 on the 0–10 scale) from baseline to 1–3 months (p < .0001) and 4–6 months (p = .004) after SBRT. Median pain failure-free duration was 13 months (range, 1–24 months). The 1-year pain failure-free rate was 55% (Figure 2). Median time-to-pain response was 1 month (range, 1 week to 5 months) (Figure 3). Overall pain response based on primary pathology was as follows: rectum (92%), kidney (67%), lung (91%), and thyroid (80%). No significant correlations existed between pain response and primary pathology. At baseline, 62 of the 66 patients were using analgesics, including non-opioid analgesics or opioid analgesics, with 40 patients using opioid analgesics. Six patients withdrew from opioid analgesics and 16 patients needed increased doses or introduction of opioid analgesics during follow-up.
Use of hormone therapies in disseminated carcinomatosis of the bone marrow associated with hormone receptor-positive breast cancer
Published in Gynecological Endocrinology, 2018
Takayo Ota, Nozomi Miyatake, Noriko Tanaka, Yoshikazu Hasegawa, Masahiro Tokunaga, Hiroshi Tsukuda, Masahiro Fukuoka
A 56-year-old female presented with back pain in the outpatient orthopedic clinic in December 2015. She had suffered from back pain since July 2015 and was treated only with nonsteroidal anti-inflammatory drugs (NSAIDs). Plain X-ray showed a compression fracture in L1. Whole-spine magnetic resonance imaging (MRI) showed multiple bone metastases (Figure 1(A,B)). Blood analysis revealed liver enzyme problems, with a low platelet count and coagulation abnormalities (Figure 2). Schistocytes were absent but myelocytes (1%) were present on the peripheral blood smear. She was admitted to the gastroenterology department of our hospital. Physical examination revealed a nodular, mobile, painless mass in the middle right region of the right breast. She had no neurological deficits. On palpation of the right breast, tumor dimensions of 65 × 70 mm were noted. No abnormal nipple discharge, nipple retraction or skin depression were observed. The left breast was normal. Computed tomography (CT) scan revealed a right breast tumor with right axillary lymph node swelling (Figure 1(C,D)). Ultrasound showed an ill-defined hypoechoic mass with central calcification. The patient was suspected to have breast cancer complicated by systemic bone metastasis and DIC. Recombinant human-soluble thrombomodulin (rhTM) treatment was initiated.