Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors

Abstract

Background: Primary and secondary malignant tumors of the spine are relatively uncommon in the pediatric population but are associated with high morbidity and significantly decreased quality of life due to pain. Local management of these tumors is often challenging due to the importance of maintaining vertebral mechanical integrity as well as the spinal growth potential. Typically, surgery and/or radiation therapy have been used in the primary management of these tumors. However, treatment options become more limited when there is relapse or refractory disease, with re-resection or additional radiotherapy often not being viable therapies. The purpose of this study was to assess the feasibility of percutaneous vertebroplasty as a palliative treatment for intractable pain secondary to malignant tumors affecting the spine. Procedure: A retrospective review of all cases of vertebroplasty performed at a single institution between 2003 and 2020. Results: A total of 11 vertebral levels were treated in 3 children with relapsed cancers (two with alveolar rhabdomyosarcoma, and one with Wilms tumor). All three had clinical benefit with sustained significant improvement in their pain. Conclusions: Vertebroplasty is a currently underutilized modality that might provide excellent pain palliation in cases of relapsed cancer in the spine. Future prospective studies of its use in pediatric oncology are needed.

Retrospective Review of 181 Patients with Pathologic Vertebral Compression Fractures

“…It is difficult to distinguish between the pathologic fracture and underlying disease as the primary reason for the loss of mobility in patients, though multiple contiguous compression fractures are associated 28 Furthermore, although AAOS strongly recommended against vertebroplasty in 2017 for adults with osteoporotic compression fractures, 29 vertebroplasty has been shown to at least be a viable palliative treatment option in children. [30][31][32] Although no outcome or comparison data is available in children with pathologic vertebral compression fractures, our practice strongly recommends bracing children at risk of progressive severe scoliosis or kyphosis, frequent follow-up, and appropriate operations in select patients who fail conservative management.…”