Original Article
Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine
Seguridad y eficacia de la cifoplastia en el tratamiento de la enfermedad tumoral de la columna vertebral
R. García-Maroto
, J. García-Coiradas, G. Milano, J.L. Cebrián, F. Marco, L. López-Durán
Corresponding author
Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
Read
1360
Timeswas read the article
364
Total PDF
996
Total HTML
Share statistics
array:24 [ "pii" => "S1988885615000759" "issn" => "19888856" "doi" => "10.1016/j.recote.2015.09.006" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "577" "copyright" => "SECOT" "copyrightAnyo" => "2014" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:406-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 34 "formatos" => array:2 [ "HTML" => 26 "PDF" => 8 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1888441515000582" "issn" => "18884415" "doi" => "10.1016/j.recot.2015.05.003" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "577" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:406-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 193 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 123 "PDF" => 67 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Seguridad y eficacia de la cifoplastia en el tratamiento de la enfermedad tumoral de la columna vertebral" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "406" "paginaFinal" => "412" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1299 "Ancho" => 1500 "Tamanyo" => 264888 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Complicaciones en la técnica quirúrgica. Fuga anterior y fuga en el trayecto de la cánula (cola) sin repercusión neurológica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. García-Maroto, J. García-Coiradas, G. Milano, J.L. Cebrián, F. Marco, L. López-Durán" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García-Maroto" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "García-Coiradas" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Milano" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "Cebrián" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Marco" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "López-Durán" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885615000759" "doi" => "10.1016/j.recote.2015.09.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000759?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441515000582?idApp=UINPBA00004N" "url" => "/18884415/0000005900000006/v1_201510290039/S1888441515000582/v1_201510290039/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1988885615000747" "issn" => "19888856" "doi" => "10.1016/j.recote.2015.09.005" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "576" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:413-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 37 "formatos" => array:2 [ "HTML" => 33 "PDF" => 4 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Treatment of proximal humeral fractures by reverse shoulder arthroplasty: Mid-term evaluation of functional results and Notching" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "413" "paginaFinal" => "420" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de resultados funcionales y Notching tras el tratamiento de fracturas de húmero mediante artroplastia total invertida a medio plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1405 "Ancho" => 950 "Tamanyo" => 118419 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Angle of the scapula neck (in the true anteroposterior positioning of the fractured shoulder): formed by the intersection of a line traced from the upper edge of the glenosphere (point a) to its lowest point (b) and from the lowest point of the glenosphere (b) to another point positioned one centimetre medially following the glenoid flange (c).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Hernández-Elena, M.Á. de la Red-Gallego, C. Garcés-Zarzalejo, M.A. Pascual-Carra, M.D. Pérez-Aguilar, T. Rodríguez-López, A. Alfonso-Fernández, M.I. Pérez-Núñez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Hernández-Elena" ] 1 => array:2 [ "nombre" => "M.Á." "apellidos" => "de la Red-Gallego" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Garcés-Zarzalejo" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Pascual-Carra" ] 4 => array:2 [ "nombre" => "M.D." "apellidos" => "Pérez-Aguilar" ] 5 => array:2 [ "nombre" => "T." "apellidos" => "Rodríguez-López" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Alfonso-Fernández" ] 7 => array:2 [ "nombre" => "M.I." "apellidos" => "Pérez-Núñez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441515000570" "doi" => "10.1016/j.recot.2015.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441515000570?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000747?idApp=UINPBA00004N" "url" => "/19888856/0000005900000006/v1_201510220017/S1988885615000747/v1_201510220017/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1988885615000760" "issn" => "19888856" "doi" => "10.1016/j.recote.2015.09.007" "estado" => "S300" "fechaPublicacion" => "2015-11-01" "aid" => "580" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:400-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 38 "formatos" => array:2 [ "HTML" => 23 "PDF" => 15 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "High recurrence and good functional results after arthroscopic resection of pigmented villonodular synovitis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "405" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alta recidiva y buenos resultados funcionales tras la resección artroscópica de la sinovitis villonodular pigmentaria de la rodilla" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1932 "Ancho" => 977 "Tamanyo" => 152384 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(a) Diffuse pigmented villonodular synovitis (DPVNS). (b) Localised pigmented villonodular synovitis (LPVNS).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Isart, P.E. Gelber, M. Besalduch, X. Pelfort, J.I. Erquicia, M. Tey-Pons, J.C. Monllau" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Isart" ] 1 => array:2 [ "nombre" => "P.E." "apellidos" => "Gelber" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Besalduch" ] 3 => array:2 [ "nombre" => "X." "apellidos" => "Pelfort" ] 4 => array:2 [ "nombre" => "J.I." "apellidos" => "Erquicia" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Tey-Pons" ] 6 => array:2 [ "nombre" => "J.C." "apellidos" => "Monllau" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441515000739" "doi" => "10.1016/j.recot.2015.05.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441515000739?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000760?idApp=UINPBA00004N" "url" => "/19888856/0000005900000006/v1_201510220017/S1988885615000760/v1_201510220017/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "406" "paginaFinal" => "412" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. García-Maroto, J. García-Coiradas, G. Milano, J.L. Cebrián, F. Marco, L. López-Durán" "autores" => array:6 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "García-Maroto" "email" => array:2 [ 0 => "maroto_cot@yahoo.es" 1 => "marotocot@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "García-Coiradas" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Milano" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "Cebrián" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Marco" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "López-Durán" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguridad y eficacia de la cifoplastia en el tratamiento de la enfermedad tumoral de la columna vertebral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1299 "Ancho" => 1500 "Tamanyo" => 264888 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Complications in the surgical technique. Anterior leak and leak in the path of the cannula (tail) with no neurological repercussions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The skeletal system is the third most frequently affected organ by metastasis, following the lung and liver.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> Studies conducted in oncological patients reflect that up to 70% of cancer patients suffer vertebral metastases throughout the course of their disease, of which only 14% are symptomatic.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The increased prevalence of cancer worldwide and the extended life expectancy of these patients has meant an increase in the incidence of bone metastases.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5,6</span></a> Vertebral metastases generally appear between the ages of 40 and 65 years,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> with their most frequent location being the spinal column (60–80%).<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">8,9</span></a> Approximately 60% of vertebral tumoral lesions are secondary to breast, lung and prostate cancers and myeloma.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">10,11</span></a> On the other hand, the incidence of vertebral fractures due to compression is estimated at 24% of patients with multiple myeloma, 14% in the case of breast cancer, 6% in prostate cancer and 8% in lung cancer.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> Thus, up to 50% of patients with myeloma present vertebral lesions, either by direct involvement or by fractures due to fragility.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">13,14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The traditional treatment of vertebral fractures by compression, based on rest and reduction of activity, often entails an unfavourable clinical and mechanical situation, persistent pain and decreased quality of life.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a> In pathological fractures linked to vertebral metastasis, radiotherapy does not protect from progressive collapse, does not achieve restoration of height, and does not treat the associated instability.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a> In such cases, balloon kyphoplasty manages to reduce pain, restores the height of the vertebral body and stabilises the spine, thus enabling an improvement in the level the activity of patients.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">17–19</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of our study was to describe the effectiveness and safety of kyphoplasty in vertebral fractures among patients with cancer in our experience (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective, descriptive study on 75 consecutive patients with metastasis or multiple myeloma affecting the spine who presented 122 acute vertebral fractures treated through kyphoplasty at our hospital between 2006 and 2012. The fractures in patients with multiple myeloma were assumed to be somehow linked to the tumoral disease.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">4,5</span></a> The diagnosis of vertebral fracture by acute compression was established by the presence of bone oedema in an MRI scan. We excluded from the study chronic fractures and those not subsidiary to treatment through balloon kyphoplasty due to involvement of the posterior wall or associated criteria of vertebral instability.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a> Kyphoplasty in patients with vertebral metastasis was indicated in type <span class="elsevierStyleSmallCaps">I</span>, <span class="elsevierStyleSmallCaps">II</span> and <span class="elsevierStyleSmallCaps">IV</span> fractures according to the Harrington classification,<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a> excluding those presenting neurological involvement, as well as in patients with intermediate scores (4–7 points) in the Tomita scale.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> Preoperative simple radiographs in 2 projections (anteroposterior and lateral) and centred on the affected vertebral level were obtained in all cases, as well as an MRI scan to specify the lesional level of the fracture, its acute character and the condition of the pedicles for the approach.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5,22</span></a> The kyphoplasty was conducted with the patient in the prone position and either local (when 1 or 2 levels were treated) or general anaesthesia (when more than 2 levels were treated). The levels were approached through a percutaneous route with bilateral transpedicular access. Sitting and walking were authorised in the first 24<span class="elsevierStyleHsp" style=""></span>h, with hospital discharge taking place during the following 24–48<span class="elsevierStyleHsp" style=""></span>h. The mean follow-up period was 11 months (range: 3–36 months) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The effectiveness of kyphoplasty was evaluated through a reduction in the intensity of pain, quality of life scales and the level of correction of vertebral body height. The results regarding pain improvement were evaluated according to a visual analogue scale (VAS) and the decrease in major opioid use following the surgery. Quality of life was evaluated according to the Karnofsky index. All the clinical results mentioned were recorded before the surgery, upon hospital discharge and at 9 or 12 months after the surgery. The height of the vertebral body was determined as a percentage of the reestablishment of said height by studying lateral radiographs of the affected spinal segment, at 9 or 12 months after the surgery. This was done by means of the technique described by the majority of existing studies,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">5,22,23</span></a> establishing the relationship between the preoperative and postoperative measurements, as well as that relative to the adjacent vertebrae.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In terms of safety, all the cement leaks were registered, even those not associated to neurological complications, along with the onset of new vertebral fractures and medical complications occurring in the immediate postoperative period. Cement leaks and the appearance of new fractures were assessed by studying conventional radiographies obtained on the first day after the intervention, in outpatient clinic 1 month after the surgery and subsequently every 3 months, until the end of the follow-up period.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All the data collection was carried out by an independent observer who did not perform any of the interventions, based on the clinical histories and the surgical protocols of each patient.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The statistical analysis of the data was carried out using the statistics software package SPSS version 15.0. The qualitative variables were described through the distribution of frequencies, whilst the quantitative variables were described through the mean and standard deviation (SD). Comparison of preoperative and postoperative qualitative and quantitative variables was done using the Anova and Mann–Whitney <span class="elsevierStyleItalic">U</span> techniques in non-normal conditions, and the Student <span class="elsevierStyleItalic">t</span> for paired samples under normal conditions. A value of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05 was considered as significant in all cases.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Among the 75 patients there were 50 females (66.6%) and 25 males (33.3%), with a mean age of 68 years (range: 42–86 years). The tumoral diagnoses were the following: 30 multiple myelomas (40%), 14 breast cancers (18.6%), 8 lung cancers (10.6%), 8 colon cancers (10.6%), 3 prostate cancers (4%) and the remaining 12 (16%) were other solid tumours.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Out of the 122 fractures, the most frequently affected spinal segment was the lumbar region (63.1%; 77 patients), followed by the dorsal region (36.9%; 45 patients). In total, 54.6% of patients underwent kyphoplasty at a single level, 33.3% at 2 levels, 8% at 3 levels and 3.9% at 4 or more levels.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Pain was improved in 91% of patients, with a mean improvement of 4.28 points at the end of the follow-up period, going from 7.49 (SD 1.19) to 3.21 (SD 0.95). Prior to the intervention, 53% of patients (40 cases) required major opioids, 36% (20 cases) required minor opioids and 20% (15 cases) were taking non-steroidal anti-inflammatory drugs. Twelve months after the intervention, only 12% of patients (9 cases) required major opioids, whilst 42% (32 patients) did not use analgesia or did so only occasionally.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Quality of life, as determined by the Karnosfky index, went from 60.2 (SD 10) to 80.7 (SD 12.1), and this difference was statistically significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.03).</p><p id="par0070" class="elsevierStylePara elsevierViewall">The greater the number of fractured vertebrae, the greater the pain and preoperative limitation, and the lower the improvement after kyphoplasty. No statistically significant differences were observed between strata.</p><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 31 (25.4%) fractures presented radiographic improvement, with a recovery of 19.7% of the total height expected from the vertebral body. In the rest of cases we did not find any observable radiographic differences. These findings did not reach statistical significance (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.07).</p><p id="par0080" class="elsevierStylePara elsevierViewall">There were no neurological or pulmonary complications linked to the technique. There were cement leaks in 7 fractures (5.7%) and none of them had neurological repercussions. In 5 cases the leak was to an adjacent disc and 2 were anterior. Three took place in patients with multiple myeloma and 4 in metastatic patients. In relation to the base disease, 1 patient died after 3 months of follow-up, and 6 died after between 6 and 9 months. A total of 11 patients presented new fractures 9–12 months after the kyphoplasty; 7 in the context of multiple myeloma with limited worsening of the initial clinical improvement.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nowadays, percutaneous balloon kyphoplasty is a standardised technique for the treatment of osteoporotic and acute vertebral fractures. Bouza et al.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> reflected this growing trend in Europe, with effectiveness and safety results which justified its use. The systematic review conducted by Robinson and Olerud<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> concluded that neither kyphoplasty nor vertebroplasty can be considered as the gold standard for the treatment of vertebral osteoporotic fractures, since, despite offering initial improvements, the long-term clinical results are close to those of fractures treated without surgery. Svedbom et al.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a> proved that, despite conservative treatment being more cost-effective and safer, the percutaneous treatment is indicated in hospitalised patients with acute fractures due to the improvement in symptoms and reduction in hospitalisation times.</p><p id="par0090" class="elsevierStylePara elsevierViewall">However, very few studies focus on acute vertebral fractures in cancer patients, whether metastatic or related to multiple myeloma. We have included them because, in addition to those directly relayed to myeloma, vertebral lesions can also be caused by the osteopenia produced.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In our study we found that kyphoplasty was an effective and safe procedure to treat vertebral fractures among cancer patients. All were acute fractures, diagnosed by MRI and in hospitalised patients.<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">23,26</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Our series included a considerable number of patients, all intervened by the same surgeon, but with methodological limitations (retrospective design, absence of a control group), which makes us cautious when presenting conclusions.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The patients presented a reduction in pain intensity evidenced by a decrease in consumption of major analgesics and improvement in the VAS (reduction of 4.28 points). There was an improvement in quality of life as assessed by the Karnosfky index, which went from 60.2 to 80.7 (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05). Pflugmacher et al.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> obtained similar results, although they used quick questionnaires for quality of life. Berenson et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> published a retrospective study with a control group, in which they compared the benefits of kyphoplasty versus non-surgical treatment of these fractures, and concluded that the former experienced a significant improvement in quality of life.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Pain reduction was maintained throughout the monitoring period, as reported by other authors.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">27–29</span></a> The appearance of new vertebral fractures produced a worsening of the quality of life achieved after the surgery, but it continued to be better than the initial value in all cases. The risk of a new fracture was higher among patients with multiple myeloma, due to the physiopathogenesis of the disease.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The grade of reestablishment of the height of the vertebral body is scarcely relevant (except in isolated cases), both in number (25.4% of vertebrae treated), and in height (19.7%). Theoretically, an anatomical restitution would enable recovery of favourable biomechanical conditions. However, often this recovery is only of a few millimetres.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">27–29</span></a> This improvement is not maintained over time and presents considerable interobserver variability.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> There are multiple studies on kyphoplasties in osteoporotic fractures which have demonstrated a reestablishment of the height of the vertebral body,<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> but there are none in relation to vertebral fractures by compression in cancer patients, in whom a similar or superior clinical improvement would be expected, with a lower restitution due to the aetiopathogenesis itself. Berenson et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> obtained improvements in the reestablishment of vertebral height in cancer patients, assessed 1 month after the surgery. This improvement was significant in the spinal column and in the dorsolumbar joint, and not significant at the lumbar level. In our study, we did not obtain significant changes at any vertebral level.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The low rate of medical, neurological and pulmonary complications reflects that kyphoplasty is a safe procedure. We did not find medical complications that were directly related to the technique. Wardlaw et al.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> published a rate of medical complications in non-operated patients which was very similar to that of intervened patients. The review of osteoporotic fractures conducted by Robinson and Olerud<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> revealed more complications among patients treated by conservative treatment, due to a longer bed time.</p><p id="par0125" class="elsevierStylePara elsevierViewall">There were 7 cases (5.7%) of cement leaks, but none was symptomatic. In 2 studies conducted in 2007 and 2008, Pflugmacher et al. published similar data regarding the treatment of metastatic fractures<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> and of fractures related to multiple myeloma.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> A correct preoperative selection of patients, who should fulfil posterior wall stability and integrity criteria, is essential to minimise these complications, as is precaution when introducing volumes of cement over 5<span class="elsevierStyleHsp" style=""></span>ml.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">5</span></a> Given the good clinical results in terms of reduction of pain and improvement of quality of life, it does not seem justified to attempt more ambitious corrections.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The appearance of new fractures causes clinical worsening. Patients with multiple myeloma presented a higher incidence of new fractures (23%). These data show that the incidence of new fractures after kyphoplasty is not higher than the incidence of new spontaneous fractures (between 19% and 24%).<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">32</span></a> Berenson et al.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a> and Wardlaw et al.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> published a similar incidence of new fractures in both groups.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Vertebral fractures in cancer patients are very present in clinical practice. Treatments based on major analgesics, chemotherapy, radiotherapy and orthosis are not always effective.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1,6,9,10</span></a> Some clinical trials<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">25,29</span></a> have reported similar rates of complications to those in any therapeutic speciality. These same studies expressed a rapid improvement of pain and capacity to stand, although the data tended to converge over time. This period works against patients with tumoral diseases, compromising their life prognosis. In addition, some studies of cost-effectiveness advocate treating acute fractures in hospitalised patients.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Based on the foregoing, we conclude that balloon kyphoplasty represents an effective technique to reduce pain associated to vertebral fractures in cancer patients, enables a reduction of drug consumption and a rapid recovery of the previous quality of life. In addition, it is a safe technique, with an incidence of medical complications similar to that obtained through the orthopaedic, non-surgical management of these fractures.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of people and animals</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres572766" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Level of evidence" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec589815" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres572765" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Nivel de evidencia" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec589814" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-27" "fechaAceptado" => "2015-05-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec589815" "palabras" => array:4 [ 0 => "Kyphoplasty" 1 => "Vertebral fracture" 2 => "Metastatic" 3 => "Myeloma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec589814" "palabras" => array:4 [ 0 => "Cifoplastia" 1 => "Fractura vertebral" 2 => "Metástasis vertebral" 3 => "Mieloma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow-up of 11 months.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Almost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed a slight worsening of the initially acquired clinical improvement. No neurological or pulmonary complications related to surgical technique were found.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Kyphoplasty is an effective and safe for treating vertebral fractures in patients with cancer.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Level of evidence</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Level <span class="elsevierStyleSmallCaps">IV.</span></p></span>" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0005" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Level of evidence" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las fracturas vertebrales en pacientes oncológicos generan dolor e incapacidad, con limitación funcional y disminución de la calidad de vida. El objetivo del estudio es valorar la eficacia y seguridad de la cifoplastia en este tipo de fracturas vertebrales en el momento agudo.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo retrospectivo de 75 pacientes oncológicos consecutivos con 122 fracturas vertebrales agudas, que fueron tratados mediante cifoplastia percutánea bilateral con balón, con un seguimiento medio de 11 meses.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se produjo mejoría del dolor en el 91% de los pacientes. La mejoría media en la Escala Visual Analógica (EVA) fue de 4,28 puntos (valour preoperatorio 7,49 [DE 1,19], postoperatorio 3,21 [DE 0,95]). Antes de la intervención necesitaban opioides mayores un 53% de los pacientes (40 casos) y al mes de la cirugía solo un 12% (9 pacientes).</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La calidad de vida determinada por el índice de Karnosfky mejoró de 60,2 (DE 10) a 80,7 (DE 12,1). En un 5,7% de las cifoplastias (7 casos) se encontraron fugas de cemento, todas ellas sin repercusión neurológica. Aparecieron nuevas fracturas en un 14% de las cifoplastias (11 casos). Este subgrupo presentó un empeoramiento discreto de la mejoría clínica adquirida inicialmente. No encontramos ninguna complicación neurológica ni pulmonar relacionada con la técnica quirúrgica que no estuviera justificada por la evolución de la enfermedad.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La cifoplastia constituye un procedimiento eficaz y seguro para el tratamiento de las fracturas vertebrales en pacientes con cáncer.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Nivel de evidencia</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Nivel <span class="elsevierStyleSmallCaps">IV</span>.</p></span>" "secciones" => array:5 [ 0 => array:1 [ "identificador" => "abst0030" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Nivel de evidencia" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Maroto R, García-Coiradas J, Milano G, Cebrián JL, Marco F, López-Durán L. Seguridad y eficacia de la cifoplastia en el tratamiento de la enfermedad tumoral de la columna vertebral. Rev Esp Cir Ortop Traumatol. 2015;59:406–412.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1488 "Ancho" => 1800 "Tamanyo" => 303297 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">(A) First left: patient with multiple myeloma and several vertebral fractures. (B) Centre: magnetic resonance imaging scan confirming the acute origin of the fractures (oedema). (C) Third right: percutaneous bilateral kyphoplasty, with a satisfactory radiographic result, with no associated complications.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1299 "Ancho" => 1500 "Tamanyo" => 264888 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Complications in the surgical technique. Anterior leak and leak in the path of the cannula (tail) with no neurological repercussions.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of cement leaks \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Incidence of new fractures \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multiple myeloma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lung cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prostate cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other tumours \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 cases (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 cases (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab934766.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Results of complications observed according to the type of primary tumour.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgery insight: current management of epidural spinal cord compression from metastatic spine disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.F. Witham" 1 => "Y.A. Khavkin" 2 => "G.L. Gallia" 3 => "J.P. Wolinsky" 4 => "Z.L. Gokaslan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ncpneuro0116" "Revista" => array:6 [ "tituloSerie" => "Nat Clin Pract Neurol" "fecha" => "2006" "volumen" => "2" "paginaInicial" => "87" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16932530" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0170" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skeletal metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Ono" 1 => "C.S. Galasko" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1995" "volumen" => "312" "paginaInicial" => "2" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7634604" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109710012003" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0175" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastatic tumors of the axial spine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.G. Perrin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Opin Oncol" "fecha" => "1992" "volumen" => "4" "paginaInicial" => "525" "paginaFinal" => "532" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1379832" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0180" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spinal metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.B. Posner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Neurologic complications or cancer" "paginaInicial" => "111" "paginaFinal" => "142" "serieFecha" => "1995" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0185" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of unilateral versus bilateral kyphoplasty in multiple myeloma patients and the importance of preoperative planning" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.D. Papanastassiou" 1 => "M. Eleraky" 2 => "R. Murtagh" 3 => "Z.T. Kokkalis" 4 => "M. Gerochristou" 5 => "F.D. Vrionis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4184/asj.2014.8.3.244" "Revista" => array:6 [ "tituloSerie" => "Asian Spine J" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "244" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24967037" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0190" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of the diagnosis and management of malignant extradural spinal cord compression: The Cancer Care Ontario Practice Guidelines Initiative's Neuro-Oncology Disease Site Group" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.A. Loblaw" 1 => "J. Perry" 2 => "A. Chambers" 3 => "N.J. Laperriere" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2005.00.067" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2005" "volumen" => "23" "paginaInicial" => "2028" "paginaFinal" => "2037" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15774794" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0195" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.G. Perrin" 1 => "A.W. Laxton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nec.2004.04.018" "Revista" => array:7 [ "tituloSerie" => "Neurosurg Clin N Am" "fecha" => "2004" "volumen" => "15" "paginaInicial" => "365" "paginaFinal" => "373" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15450871" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109708014162" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0200" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of palliative external beam radiation therapy in boney metastases pain management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Cai" 1 => "N.A. Nickman" 2 => "D.K. Gaffney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/15360288.2012.757267" "Revista" => array:6 [ "tituloSerie" => "J Pain Palliat Care Pharmacother" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "28" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23394451" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0205" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer of the spine: how big is the problem?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.U. Lewandrowski" 1 => "G.R. Bell" 2 => "R.F. McLain" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cancer in the spine: comprehensive care" "paginaInicial" => "1" "paginaFinal" => "5" "serieFecha" => "2006" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0210" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumors of the spine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.F. McLain" 1 => "J.N. Weintein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Semin Spine Surg" "fecha" => "1990" "volumen" => "2" "paginaInicial" => "157" "paginaFinal" => "180" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0215" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features of metastatic bone disease and risk of skeletal morbidity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.E. Coleman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Cancer Res" "fecha" => "2006" "volumen" => "12" "paginaInicial" => "6243" "paginaFinal" => "6249" "itemHostRev" => array:3 [ "pii" => "S0735109704013300" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0220" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathologic fractures correlate with reduced survival in patients with malignant bone disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Saad" 1 => "A. Lipton" 2 => "R. Cook" 3 => "Y.M. Chen" 4 => "M. Smith" 5 => "R. Coleman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.22991" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2007" "volumen" => "110" "paginaInicial" => "1860" "paginaFinal" => "1867" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17763372" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0225" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skeletal complications of malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.E. Coleman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1997" "volumen" => "80" "paginaInicial" => "1588" "paginaFinal" => "1594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9362426" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0230" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of fracture after single fraction image-guided intensity-modulated radiation therapy to spinal metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.S. Rose" 1 => "I. Laufer" 2 => "P.J. Boland" 3 => "A. Hanover" 4 => "M.H. Bilsky" 5 => "J. Yamada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2008.19.3508" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "5075" "paginaFinal" => "5079" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19738130" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0235" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of vertebral fractures by kyphoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. De Lamo-Rovira" 1 => "J.L. Cebrián-Parra" 2 => "A. Francés" 3 => "F. Marco-Martínez" 4 => "C. León-Serrano" 5 => "L. López- Durán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Ortop Traumatol" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "15" "paginaFinal" => "20" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0240" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimally invasive treatments for spinal metastases vertebroplasty, kyphoplasty, and radiofrequency ablation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.J. Halpin" 1 => "B.R. Bendok" 2 => "J.C. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Support Oncol" "fecha" => "2004" "volumen" => "2" "paginaInicial" => "339" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15357518" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0245" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Bouza" 1 => "T. López" 2 => "A. Magro" 3 => "L. Navalpotro" 4 => "J.M. Amate" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-005-0048-x" "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2006" "volumen" => "15" "paginaInicial" => "1050" "paginaFinal" => "1067" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16429288" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0250" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.S. Taylor" 1 => "P. Fritzell" 2 => "R.J. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-007-0308-z" "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2007" "volumen" => "16" "paginaInicial" => "1085" "paginaFinal" => "1100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17277923" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0255" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Berenson" 1 => "R. Pflugmacher" 2 => "P. Jarzem" 3 => "J. Zonder" 4 => "K. Schechtman" 5 => "J.B. Tillman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(11)70008-0" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "225" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21333599" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0260" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastatic disease of the spine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.D. Harrington" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "1986" "volumen" => "68A" "paginaInicial" => "1110" "paginaFinal" => "1115" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0265" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical strategy for spinal metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Tomita" 1 => "N. Kawahara" 2 => "T. Kobayashi" 3 => "A. Yoshida" 4 => "H. Murakami" 5 => "T. Akamaru" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "298" "paginaFinal" => "306" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0270" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kyphoplasty in osteoporotic vertebral compression fractures – guidelines and technical considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Robinson" 1 => "C.E. Heyde" 2 => "P. Försth" 3 => "C. Olerud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1749-799X-6-43" "Revista" => array:5 [ "tituloSerie" => "J Orthop Surg Res" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21854577" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0275" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Tosi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Scientifica (Cairo)" "fecha" => "2013" "paginaInicial" => "104546" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0280" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe: a meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Bouza" 1 => "T. López-Cuadrado" 2 => "N. Almendro" 3 => "J.M. Amate" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-014-3581-7" "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2015" "volumen" => "24" "paginaInicial" => "715" "paginaFinal" => "723" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25399304" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0285" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vertebroplasty and kyphoplasty – a systematic review of cement augmentation techniques for osteoporotic vertebral compression fractures compared to standard medical therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Robinson" 1 => "C. Olerud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.maturitas.2012.02.010" "Revista" => array:6 [ "tituloSerie" => "Maturitas" "fecha" => "2012" "volumen" => "72" "paginaInicial" => "42" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22425141" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0290" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balloon kyphoplasty compared to vertebroplasty and nonsurgical management in patients hospitalised with acute osteoporotic vertebral compression fracture: a UK cost-effectiveness analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Svedbom" 1 => "L. Alvares" 2 => "C. Cooper" 3 => "D. Marsh" 4 => "O. Ström" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00198-012-2102-y" "Revista" => array:6 [ "tituloSerie" => "Osteoporos Int" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "355" "paginaFinal" => "367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22890362" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0295" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balloon kyphoplasty in the treatment of metastatic disease of the spine: a 2-year prospective evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Pflugmacher" 1 => "R. Taylor" 2 => "A. Agarwal" 3 => "I. Melcher" 4 => "A. Dish" 5 => "N.P. Haas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-008-0701-2" "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2008" "volumen" => "17" "paginaInicial" => "1042" "paginaFinal" => "1048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18560905" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0300" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional results of vertebral augmentation techniques in pathological vertebral fractures of myelomatous patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.C. Kose" 1 => "O. Cebesoy" 2 => "B. Akan" 3 => "L. Altinel" 4 => "D. Dincer" 5 => "T. Yazar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Natl Med Assoc" "fecha" => "2006" "volumen" => "98" "paginaInicial" => "1654" "paginaFinal" => "1658" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17052058" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0305" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective two-year follow-up of thoracic and lumbar osteolytic vertebral fractures caused by multiple myeloma treated with balloon kyphoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Pflugmacher" 1 => "A. Schulz" 2 => "R.J. Schroeder" 3 => "K.D. Schaser" 4 => "C.K. Klostermann" 5 => "I. Melcher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-960502" "Revista" => array:6 [ "tituloSerie" => "Z Orthop Ihre Grenzgeb" "fecha" => "2007" "volumen" => "145" "paginaInicial" => "39" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17345542" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0310" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Voggenreiter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Spine" "fecha" => "2005" "volumen" => "30" "paginaInicial" => "2806" "paginaFinal" => "2812" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16371909" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0315" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Wardlaw" 1 => "S.R. Cummings" 2 => "J. Van Meirhaeghe" 3 => "L. Bastian" 4 => "J.B. Tillman" 5 => "J. Ranstam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)60010-6" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "373" "paginaInicial" => "1016" "paginaFinal" => "1024" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19246088" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0320" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of new vertebral fracture in the year following a fracture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Lindsay" 1 => "S.L. Silverman" 2 => "C. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2001" "volumen" => "285" "paginaInicial" => "320" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11176842" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000005900000006/v1_201510220017/S1988885615000759/v1_201510220017/en/main.assets" "Apartado" => array:4 [ "identificador" => "7577" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005900000006/v1_201510220017/S1988885615000759/v1_201510220017/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000759?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 14 | 5 | 19 |
| 2024 September | 14 | 3 | 17 |
| 2024 August | 19 | 3 | 22 |
| 2024 July | 18 | 6 | 24 |
| 2024 June | 22 | 2 | 24 |
| 2024 May | 16 | 2 | 18 |
| 2024 April | 25 | 11 | 36 |
| 2024 March | 43 | 4 | 47 |
| 2024 February | 65 | 9 | 74 |
| 2024 January | 37 | 6 | 43 |
| 2023 December | 19 | 4 | 23 |
| 2023 November | 21 | 9 | 30 |
| 2023 October | 32 | 13 | 45 |
| 2023 September | 14 | 2 | 16 |
| 2023 August | 17 | 8 | 25 |
| 2023 July | 12 | 9 | 21 |
| 2023 June | 27 | 2 | 29 |
| 2023 May | 32 | 6 | 38 |
| 2023 April | 33 | 6 | 39 |
| 2023 March | 27 | 3 | 30 |
| 2023 February | 19 | 3 | 22 |
| 2023 January | 55 | 11 | 66 |
| 2022 December | 19 | 3 | 22 |
| 2022 November | 33 | 10 | 43 |
| 2022 October | 21 | 12 | 33 |
| 2022 September | 17 | 12 | 29 |
| 2022 August | 13 | 6 | 19 |
| 2022 July | 18 | 19 | 37 |
| 2022 June | 14 | 7 | 21 |
| 2022 May | 16 | 11 | 27 |
| 2022 April | 15 | 12 | 27 |
| 2022 March | 30 | 7 | 37 |
| 2022 February | 18 | 5 | 23 |
| 2022 January | 32 | 6 | 38 |
| 2021 December | 13 | 9 | 22 |
| 2021 November | 7 | 6 | 13 |
| 2021 October | 12 | 17 | 29 |
| 2021 September | 8 | 14 | 22 |
| 2021 August | 10 | 9 | 19 |
| 2021 July | 13 | 7 | 20 |
| 2021 June | 10 | 11 | 21 |
| 2021 May | 19 | 3 | 22 |
| 2021 April | 20 | 25 | 45 |
| 2021 March | 7 | 5 | 12 |
| 2021 February | 14 | 8 | 22 |
| 2021 January | 7 | 5 | 12 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 3 | 2 | 5 |
| 2017 December | 13 | 2 | 15 |
| 2017 November | 2 | 2 | 4 |
| 2016 September | 1 | 1 | 2 |
| 2016 February | 0 | 1 | 1 |
Show all
