Vertebral Augmentation for Compression Fractures Caused by Malignant Disease

Abstract

Vertebral compression fractures are common in malignant disease and frequently cause severe back pain. However, management of that pain with conventional medical, radiotherapy, or surgical modalities is often inadequate. Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, are minimally invasive techniques in which methylmethacrylate bone cement is percutaneously injected into compressed vertebral bodies. Vertebral augmentation often improves mechanical stability of compressed vertebrae, provides pain relief, and may prevent progression of vertebral collapse. Kyphoplasty may provide increased chance for vertebral body height restoration, but the clinical importance of slight change in vertebral body height is unclear. Vertebral augmentation can be used in conjunction with other treatment modalities, and associated pain relief may improve patient tolerance of needed antitumor therapies, such as radiation therapy. Vertebral augmentation is generally very well tolerated, and complications associated with bone cement extravasation beyond the vertebral body have rarely been reported. Because it often provides good to excellent relief of otherwise intractable pain and is generally well tolerated, vertebral augmentation is becoming a first-line agent for management of painful vertebral compression fractures, especially in the setting of malignant disease.

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…Vertebral augmentation helps restore mechanical stability while reducing pain and neurologic symptoms. [282][283][284][285][286][287] Ablation techniques may also be helpful for pain management in patients who receive inadequate relief from pharmacologic therapy. Additionally, these approaches could be considered for patients who do not prefer or are not indicated for receiving additional pharmacologic interventions or radiation therapy.…”

Adult Cancer Pain

“…Vertebroplasty/kyphoplasty helps restore mechanical stability while reducing pain and neurologic symptoms. 160–165 …”

Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures

“…However, the technique is less useful in reducing kyphotic deformity. Rastogi et al [18] described vertebroplasty as a painreducing technique that is well tolerated, but only able to prevent kyphosis from worsening. Percutaneous pedicle screw fixation is a minimally invasive technique that can be combined with vertebroplasty, allowing a satisfactory reduction of the traumatic kyphosis with low complication rates and a short operative time.…”