Anterolateral Cervical Kyphoplasty for Metastatic Cervical Spine Lesions

Abstract

Study DesignRetrospective case series.PurposeTo evaluate the clinical and radiological efficacy of anterolateral kyphoplasty for cervical spinal metastasis.Overview of LiteratureAlthough the spine is the third most common site of tumor metastasis, the cervical spine is the least commonly affected (incidence, 10%–15%). Surgical decompression is highly challenging because of the proximity of neural and vascular elements. Kyphoplasty for cervical spine metastasis has been described in small case reports with promising results.MethodsRetrospective analysis of a prospective collected single-center spine metastasis database was done for cervical kyphoplasty cases. Data pertaining to age, sex, primary tumor diagnosis, modified Tokuhashi score, Spinal Instability Neoplastic Score (SINS), preoperative Visual Analog Scale (VAS) score, and analgesic medication were extracted. Postoperative data included VAS score at postoperative day 1, duration of hospitalization, self-reported functional outcome, and VAS score at the last follow-up.ResultsEleven patients (mean age, 62.5 years) with cervical spine metastases were treated with 15-level kyphoplasty. Mean Tokuhashi score was 8.1, and mean SINS was 7.85. Mean preoperative pain score was 7.1, and 82% of patients used opioid analgesics. Mean total bleeding volume was 100 mL. Mean complication-free length of stay was 2.6 days with a decrease in postoperative pain (VAS score=2.8, p <0.05). There was a 56% decrease in opioid dosage and the number of consumed analgesics (1.09, p =0.004). Eighty-two percent of the patients reported excellent improvement at the last follow-up self-assessment.ConclusionsTo our knowledge, this case series represents the largest series of vertebral augmentation using balloon kyphoplasty for cervical spinal metastasis. This technique is associated with low postoperative complications as well as significant decrease in pain, use of opioids, and length of hospital stay. The main indications for vertebral kyphoplasty are lytic lesions of the cervical spine, painful lesions refractory to medical treatment, SINS score of 6–10, and absence of posterior wall defect.

The Palliative Care in the Metastatic Spinal Tumors. A Systematic Review on the Radiotherapy and Surgical Perspective

“…Percutaneous vertebroplasty (PVP) was first introduced as a treatment option for aggressive hemangiomas of the lumbar spine [91]. Over the years, PVP has been used for the treatment of painful vertebral metastases, with great efficacy in relieving pain, restoring spine stability and improving patient's QoL.…”

“…BKP is used to restore vertebral height through an inflatable balloon to reduce the pressure of cement injection and the risk of leakage. This technique seems to be associated with low postoperative complications as well as significant decrease in pain, use of opioids and length of hospital stay [91]. BKP main indications are painful or lytic vertebral metastases and absence of posterior wall defect.…”

Safety and effectiveness of cervical vertebroplasty: report of a large cohort and systematic review

“…Procedure-related deaths have been reported ranging from 0 to 9% [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. One pulmonary decompensation secondary to cVP has been reported by Sebaaly et al [15] in their cases series, leading to a 9% death rate. In the present series, one procedure-related death (0.7% rate) was recorded due to cement migration in the vertebrobasilar system.…”

“…In 10.5% of the cases, pain was stable. In the literature, pain relief is reported varying from 80 to 100% [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] ( Table 2). The pain relief rate in this series was slightly lower than the ones reported in the literature, which may be explained by the fact that very challenging lesions were included in this series (17.3% of the lesions presented a posterior wall disruption and 26.5% had a contact with the transverse canal).…”

“…Additionally, potential bone cement migration posteriorly into the spinal canal during cVP may lead to devastating sequelae like tetraparesis or even death in case of cervical spinal cord compression. Only limited data, mainly short case series [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], are available in the literature on the safety and effectiveness of cVP.…”