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4:47 Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients

2002; Elsevier BV; Volume: 2; Issue: 5 Linguagem: Inglês

10.1016/s1529-9430(02)00323-6

1878-1632

Daryl R. Fourney, Donald F. Schomer, Remi Nader, Jennifer Fourney-Chlan, Ziya L. Gokaslan,

Spine and Intervertebral Disc Pathology

Purpose of study: Minimally invasive vertebroplasty—which involves the percutaneous injection of polymethylmethacrylate bone cement into a vertebral body—was developed in France in the 1980s. The indication for treatment is the management of pain, likely caused by structural instability of the vertebral body. Percutaneous balloon kyphoplasty, a recent modification of vertebroplasty, involves inflation of a balloon into the collapsed vertebral body to restore height and reduce kyphotic deformity, prior to stabilization with bone cement. The current North American experience with both procedures is largely limited to the treatment of benign osteoporotic compression fractures. The objective of this study was to assess the safety and efficacy of vertebroplasty and kyphoplasty in the treatment of painful vertebral body fractures in cancer patients. Methods used: We reviewed a consecutive group of patients undergoing vertebroplasty and kyphoplasty at out institution between October 2000 and February 2002. Five patients treated for benign osteoporotic compression fractures were excluded. Ninety-seven procedures (65 vertebroplasties and 32 kyphoplasties) were performed in 56 patients during 58 treatment sessions. Mean age was 62 years (range, 30–81 yr) and mean duration of symptoms was 5.3 months. Indications for treatment were intractable spinal pain from osteolytic disease and instability secondary to metastases (35 patients) or myeloma (21 patients). Symptomatic levels were identified by correlating the clinical data with MRI and radiographic findings. of findings: Patients noted marked or complete pain relief after 51 procedures (88%), and no change after 3 procedures (5%); data were incomplete in four patients (7%). No patient was worse after treatment. Reductions in visual analog pain scores remained significant up to 1 year (p=.02, Wilcoxon signed-rank test). After a mean follow-up of 4.3 months, only one patient had died; mean survival, as determined by Kaplan-Meier analysis, was 12.9 months. There were no deaths or complications related to the procedures. One patient was readmitted to hospital 15 days after kypho-plasty for an exacerbation of preexisting congestive heart failure. A patient with metastatic esthesioneuroblastoma developed sudden paraplegia 13 days after an L1 vertebroplasty secondary to spinal cord compression caused by a progressive T8 epidural metastasis. Relationship between findings and existing knowledge: The efficacy of vertebroplasty in the present report is similar to the two comparable European series [1,2]. A lack of complications related to bone cement leakage may reflect the use of relatively smaller injection volumes. To the authors' knowledge, kyphoplasty in the setting of cancer has not been previously reported. Overall significance of findings: Percutaneous vertebroplasty and kyphoplasty provided significant pain relief in a high percentage of patients that appears to be durable over time. Precise indications for each of these techniques are evolving; however, they are safe and feasible in well-selected patients with refractory spinal pain resulting from myeloma bone disease or metastases. Disclosures: Device or drug: vertebroplasty. Status: approved. Device or drug: kyphoplasty. Status: approved. Conflict of interest: No conflicts.