Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The current North American experience with minimally invasive vertebro- and kyphoplasty is largely limited to the treatment of benign osteoporotic compression fractures. The objective of this study was to assess the safety and efficacy of these procedures for painful vertebral body (VB) fractures in cancer patients.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The authors reviewed a consecutive group of cancer patients (21 with myeloma and 35 with other primary malignancies) undergoing vertebro- and kyphoplasty at their institution. Ninety-seven (65 vertebro- and 32 kyphoplasty) procedures were performed in 56 patients during 58 treatment sessions. The mean patient age was 62 years (± 13 years [standard deviation]) and the median duration of symptoms was 3.2 months. All patients suffered intractable spinal pain secondary to VB fractures.</jats:p> <jats:p content-type="fine-print">Patients noted marked or complete pain relief after 49 procedures (84%), and no change after five procedures (9%); early postoperative Visual Analog Scale (VAS) pain scores were unavailable in four patients (7%). No patient was worse after treatment. Reductions in VAS pain scores remained significant up to 1 year (p = 0.02, Wilcoxon signed-rank test). Analgesic consumption was reduced at 1 month (p = 0.03, Wilcoxon signed-rank test). Median follow-up length was 4.5 months (range 1 day–19.7 months). Asymptomatic cement leakage occurred during vertebroplasty at six (9.2%) of 65 levels; no cement extravasation was seen during kyphoplasty. There were no deaths or complications related to the procedures. The mean percentage of restored VB height by kyphoplasty was 42 ± 21%.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Percutaneous vertebro- and kyphoplasty provided significant pain relief in a high percentage of patients, and this appeared durable over time. The absence of cement leakage—related complications may reflect the use of 1) high-viscosity cement; 2) kyphoplasty in selected cases; and 3) relatively small 3volume injection. Precise indications for these techniques are evolving; however, they are safe and feasible in well-selected patients with refractory spinal pain due to myeloma bone disease or metastases.</jats:p>

Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review

“…While the duration of follow-up varies from 3 to 24 months, it generally does not exceed 10-12 months-and an important number of losses are also seen during this period. In effect, in some studies [11] the final populations do not reach 20% of the patients actually treated. Only one study [25] explicitly indicates that analysis of the results is made on an intention to treat basis.…”

“…Five studies [11,25,41,56] are comparative and include 220 patients, of which 118 were subjected to BK. Although the number of VCFs per patient is not uniform, most studies involve only a single procedure per patient (generally under general anesthesia).…”

“…The results of a retrospective analysis contrasting BK versus vertebroplasty in tumoral VCFs [11] show that, globally, no significant differences are found between the two techniques in terms of pain relief [OR (95% CI): 0.89 (0.29-2.67); P=0.8] or the degree of functional improvement achieved. BK produced a significant increase (P=0.01) in vertebral height, with a mean value of 4.5±3.6 mm-which implies a 42±21% restoration of the height lost.…”

Spinal extradural arachnoid cyst following percutaneous vertebroplasty

“…The chemical and thermal cytotoxicity of PMMA cement also may have analgesic and anti-tumor effects [4]. Although vertebroplasty gives low peri-and postsurgery morbidity and good pain control [1,5,11], it does not allow good local control of disease and may cause local metastases [6]. So, vertebral augmentation should be combined with radiotherapy or chemotherapy to achieve a better local control of the tumor [14,19].…”

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

“…Spinal [9,17]. In addition, percutaneous vertebroplasty and kyphoplasty have been shown to be safe and effective techniques for treating intractable pain secondary to pathological vertebral fractures of metastatic spine disease [14].…”