Percutaneous vertebroplasty and kyphoplasty performed at a cancer center: refuting proposed contraindications.
OBJECTIVE
The purpose of this study was to examine a group of patients with cancer who underwent a vertebroplasty or a kyphoplasty for a vertebral body (VB) fracture, even though the procedure may have been considered contraindicated based on previous reports in the literature.


METHODS
The electronic database maintained by the Departments of Neurosurgery and Anesthesiology-Pain Management at the University of Texas M. D. Anderson Cancer Center was searched for patients who underwent vertebroplasty or kyphoplasty between January 2001 and July 2003. The criteria defining a contraindicated procedure were based on a review of the literature. Group I consisted of patients who did not undergo a contraindicated vertebroplasty or kyphoplasty, whereas Group II consisted of patients who underwent one of these procedures even though it may have been considered contraindicated. There were 53 patients with fractures at 132 levels who met the criteria for the study. Of these, 17 patients with fractures at 18 levels (14% of total) were considered to have undergone a contraindicated vertebroplasty or kyphoplasty (Group II). There were 12 complications (11%) in the 114 levels in Group I and seven complications (39%) in the 18 levels in Group II (p = 0.03). The most common complication was cement extrusion from the anterior VB that did not involve the venous system. No patient required an open surgical procedure to remove extruded cement.


CONCLUSIONS
Vertebroplasty and kyphoplasty appear to be safe and effective in the setting of severe back pain caused by VB fracture that is unresponsive to other therapies, even in the presence of relative contraindications to the procedures.
Hentschel
Stephen J
SJ
Department of Neurosurgery and Anesthesiology-Pain Management, The University of Texas M D Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Burton
Allen W
AW
Fourney
Daryl R
DR
Rhines
Laurence D
LD
Mendel
Ehud
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D001843:Bone Cements / Q000627:therapeutic use; D002173:Cancer Care Facilities; D000075202:Contraindications; D017587:Diskectomy, Percutaneous / Q000379:methods; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000534:rehabilitation; D009369:Neoplasms / Q000150:complications*; D019637:Orthopedic Procedures / Q000379:methods*; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
D001843:Bone Cements