Osteoblastic and mixed spinal metastases: evaluation of the analgesic efficacy of percutaneous vertebroplasty.
OBJECTIVE
To determine the analgesic efficacy of percutaneous vertebroplasty in treating osteoblastic and mixed spinal metastases.


METHODS
Fifty-two patients underwent 59 vertebroplasty procedures for 103 painful vertebral metastases, among which 53 were pure osteoblastic and 50 were mixed (blastic and lytic). Analgesic efficacy was classified as "excellent," "good," "fair," and "poor." The patients were followed up at 1 month, 6 months, 12 months, 2 years, and 5 years. The mean follow-up period was 17 months.


RESULTS
The analgesic efficacy rate was 86% at 1 month and 92% at 6 months (among which 71% of patients had "excellent" results and 21% had with "good" results). In most cases, it was stable. It was correlated with vertebral filling quality (Fisher test, P = .0932 at 1 month follow-up) but neither with filling volume (Mann-Whitney test, P = .143 at 1 month) nor with the vertebral structure, pure blastic or mixed (Fisher test, P = .784 at 1 month). There were 5 filling failures (4.7%) whose occurrence was correlated with the pure blastic structure of the vertebra (Mann-Whitney test, P = .033). Local clinical complications were observed in 5 cases (8.5%): 1 transitory radiculalgia (1.7%), 2 durable radiculalgias (3.4%), 1 cauda equina syndrome (1.7%), and 1 hemothorax (1.7%). General clinical complications were 2 pulmonary embolisms (3.4%). No patients died. The occurrence of clinical complications was not correlated with the vertebral structure (Fisher test, P = .279).


CONCLUSIONS
Vertebroplasty for osteoblastic and mixed metastases allows, with a well-trained operator, a satisfactory anesthesia with acceptable clinical complication rates.
Calmels
V
V
Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. valerie_calmels@yahoo.fr
Vallée
J-N
JN
Rose
M
M
Chiras
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D010006:Osteoblasts / Q000473:pathology*; D059408:Pain Management; D011471:Prostatic Neoplasms / Q000473:pathology; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D014057:Tomography, X-Ray Computed
D001843:Bone Cements