Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Hematology


Answer 3
  1. Evaluation for vertebroplasty or kyphoplasty. This patient’s pain is due to an acute compression fracture (Figure 2) and the resultant edema and inflammation. The MRI findings are typical of an acute fracture and have also ruled out an associated soft tissue mass (plasmacytoma) and cord compression; thus, neurosurgical decompression is not indicated. Likewise, this patient’s symptoms are due to mechanical consequences of an acute fracture, and radiotherapy is not likely to relieve these symptoms. Vertebroplasty or kyphoplasty are minimally invasive spinal procedures that stabilize the fractured vertebral body and can provide rapid pain relief in many cases. The neurologic symptoms described predated the onset of back pain and are common side effects of thalidomide and vincristine, 2 commonly used therapies for MM. A compression fracture in a patient with previously documented skeletal disease is not necessarily evidence of myeloma progression, and other testing to reassess MM should be undertaken prior to switching therapy. Bisphosphonate therapy is considered standard therapy for MM patients with lytic bone disease, as randomized studies have shown that bisphosphonates are useful in preventing compression fractures and other skeletal complications of MM. This patient should have already been on either monthly zoledronic acid or pamidronate from the time of diagnosis; these drugs do not have any role in the management of an acute pathologic fracture.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 8/6/07 • kkj