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


METHODS
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. 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%.


CONCLUSIONS
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 volume 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.
Fourney
Daryl R
DR
Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Schomer
Donald F
DF
Nader
Remi
R
Chlan-Fourney
Jennifer
J
Suki
Dima
D
Ahrar
Kamran
K
Rhines
Laurence D
LD
Gokaslan
Ziya L
ZL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001827:Body Height; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications*; D011183:Postoperative Complications; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary
D001843:Bone Cements