Percutaneous Interventional Management of Spinal Metastasis

Lee, Seon Kyu; Weiss, Brandon; Yanamadala, Vijay; Brook, Allan

doi:10.1055/s-0039-1694698

Cited by 10 publications

(6 citation statements)

References 50 publications

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“…After Patchell's report, which proved the efficacy of palliative surgery over radiation therapy [4], the number of surgeries have increased over time with the development of surgical methods and instruments [5,6]. Percutaneous vertebroplasty (VP)/balloon kyphoplasty (BKP) [7], decompression [8], spinal instrumentation [9], and a combination of these methods, with or without tumor resection [10,11], are standard options for palliative surgery. The indication and selection of surgical methods are determined by the invasiveness of the methods and patients' life expectancy; however, it is sometimes difficult to achieve a good outcome due to their condition and/or rapid progression of primary cancer.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors

Suzuki¹,

Terai²,

Takahashi³

et al. 2023

JCM

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Palliative surgery is performed to improve the quality of life of patients with spinal metastases. However, it is sometimes difficult to achieve the expected results because the patient’s condition, and risk factors related to poor outcomes have not been well elucidated. This study aimed to evaluate the functional outcomes and investigate the risk factors for poor outcomes after palliative surgery for spinal metastasis. We retrospectively reviewed the records of 117 consecutive patients who underwent palliative surgery for spinal metastases. Neurological and ambulatory statuses were evaluated pre- and post-operatively. Poor outcomes were defined as no improvement or deterioration in functional status or early mortality, and the related risk factors were analyzed using multivariate logistic regression analysis. The results showed neurological improvement in 48% and ambulatory improvement in 70% of the patients with preoperative impairment, whereas 18% of the patients showed poor outcomes. In the multivariate analysis, low hemoglobin levels and low revised Tokuhashi scores were identified as risk factors for poor outcomes. The present results suggest that anemia and low revised Tokuhashi scores are related not only to life expectancy but also to functional recovery after surgery. Treatment options should be carefully selected for the patients with these factors.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors

Suzuki¹,

Terai²,

Takahashi³

et al. 2023

JCM

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“…In US, this is the second cause of death and the median overall survival after surgery is 8.5 months in patients with colon, breast, prostate, thyroid, renal cell, lung, and skin cancers. Until recent times, palliation is the aim of most treatments; nevertheless, several advanced techniques can ensure a better quality of life and increase life expectancy in patients with spinal metastases (3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Management of Spinal Bone Metastases With Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center Case Series

et al. 2022

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Spine is a frequent site of bone metastases, with a 8.5 months median survival time after diagnosis. In most cases treatment is only palliative. Several advanced techniques can ensure a better Quality of Life (QoL) and increase life expectancy. Radiofrequency ablation (RFA) uses alternating current to produce local heating and necrosis of the spinal lesion, preserving the healthy bone. RFA is supported by vertebral reinforcement through kyphoplasty and vertebroplasty in order to stabilize the fracture with polymethylmethacrylate (PMMA) injection, restoring vertebral body height and reducing the weakness of healthy bone. The aim of this study is to demonstrate the efficacy and advantages of RFA plus vertebral reinforcement through PMMA vertebroplasty and fixation in patients affected by bone spinal metastases. We retrospectively analyzed 54 patients with thoraco-lumbar metastatic vertebral fractures admitted to our Unit between January 2014 and June 2020. Each patient underwent RFA followed by PMMA vertebroplasty and transpedicle fixation. We evaluated pain relief through the Visual Analogue Scale (VAS) Score and PMMA vertebral filling based on the mean Saliou filling score. Analysis of variance (ANOVA) was used to test pain relief with statistical significance for p<0.05. A total of 54 patients (median age 63,44 years; range 34-86 years), with a total of 63 infiltrated vertebrae, were treated with RFA, PMMA vertebroplasty and transpedicular screw fixation; average operative time was 60.4 min (range 51–72). The preoperative average VAS score decreased significantly from 7.81 to 2.50 (p < 0.05) after 12 months. Based on Saliou filling score, filling was satisfactory (12–18) in 20 vertebrae (31,7%), mediocre (6–11) in 33 vertebrae (52,4%), inadequate (0–5) in 10 vertebrae (15,9%). A consistent PMMA filling of vertebral bodies was successfully achieved with significant pain relief. Concomitant RFA, PMMA vertebroplasty and pedicle screw fixation represent a safe and effective technique for the management of spinal metastases, improving clinical outcome and pain control.

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“…Therefore, percutaneous vertebroplasty, a minimally invasive procedure, was developed to treat spine metastases, which has become one of the fastest emerging procedures in spine surgery [ 4 ]. This technique consists of percutaneous injection of polymethylmethacrylate (PMMA) into vertebrae body through transpedicular approach, which is proved to be an effective technique for promptly obtaining pain relief, controlling local tumor burden, preventing further vertebral collapse or spinal cord compression, and facilitating the return to early systemic and radiation therapy [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of early vascular cement leakage following percutaneous vertebroplasty in spine metastases: the Peking University First Hospital Score (PUFHS)

et al. 2021

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Background Cement leakage into venous blood posed significant challenge to surgeons. The aim of the study was to create a Peking University First Hospital Score (PUFHS) which could evaluate the probability of vascular cement leakage among spine metastases patients following percutaneous vertebroplasty. Methods The study retrospectively enrolled 272 spine metastases patients treated with percutaneous vertebroplasty. We randomly extracted all enrolled patients as the training or validation group and baseline characteristic comparison was assessed between the two groups. Creation of the PUFHS was performed in the training group and validation of the PUFHS was performed in the validation group. Results Of all the 272 patients, the total number of included vertebrae was 632 and the median treated levels were 2 per patient. Vascular cement leakage occurred in 26.47% (72/272) of patients. The baseline characteristics were comparable between the two groups (P > 0.05). Three risk predictors (primary cancer types, number of treated vertebrae levels, and vertebrae collapse) were included in the PUFHS. The area under the receiver operating characteristic curve (AUROC) of the PUFHS was 0.71 in the training group and 0.69 in the validation group. The corresponding correct classification rates were 73.0 and 70.1%, respectively. The calibration slope was 0.78 (95% confidence interval[CI]: 0.45–1.10) in the training group and 1.10 (95% CI: 0.73–1.46) in the validation group. The corresponding intercepts were 0.06 (95% CI: − 0.04–0.17) and − 0.0079 (95% CI: − 0.11–0.092), respectively. Conclusions Vascular cement leakage is common among spine metastases after percutaneous vertebroplasty. The PUFHS can calculate the probability of vascular cement leakage, which can be a useful tool to inform surgeons about vascular cement leakage risk in advance.

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Percutaneous Interventional Management of Spinal Metastasis

Cited by 10 publications

References 50 publications

Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors

Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors

Management of Spinal Bone Metastases With Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center Case Series

Prediction of early vascular cement leakage following percutaneous vertebroplasty in spine metastases: the Peking University First Hospital Score (PUFHS)

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