title: Minimally invasive procedures for the management of vertebral bone pain due to cancer: The EAPC recommendations.
abstract: Image-guided percutaneous ablation methods have proved effective for treatment of benign bone tumors and for palliation of metastases involving the bone. However, the role of these techniques is controversial and has to be better defined in the setting of palliative care.
  
  
  
  A systematic review of the existing data regarding minimally invasive techniques for the pain management of vertebral bone metastases was performed by experts of the European Palliative Care Research Network.
  
  
  
  Only five papers were taken into consideration after performing rigorous screening according to inclusion and exclusion criteria (low number of patients, retrospective series, proceedings).
  
  
  
  According to the present data a recommendation should be made to perform kiphoplasty in patients with vertebral tumors or metastases. However, the strength of this recommendation was based on one randomized controlled study. Several weaknesses and low quality of study design were observed with other techniques.
  
  
  
  Further randomized controlled trials are required to improve the strength of evidence available to suggest these procedures on large scale. Until then, the balance of evidence favors the use of these procedures in a small select cohort of patients with severe and disabling back pain refractory to medical therapy.
authors.affiliation: a Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit , La Maddalena Cancer Center , Palermo , Italy .
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Mercadante
authors.affiliation: b Department of Intensive Care Medicine , St. Olavs University Hospital , Trondheim , Norway .|c Department of Circulation and Medical Imaging , Norwegian University of Science and Technology , Trondheim , Norway .
authors.forename: Pål
authors.initials: P
authors.lastname: Klepstad
authors.affiliation: d Section of Palliative Medicine, Department of Oncology , Rigshospitalet, Copenhagen University Hospital , Denmark .|e Multidisciplinary Pain Centre, Department Neuroanaesthesiology , Rigshospitalet, Copenhagen University Hospital , Denmark .
authors.forename: Geana Paula
authors.initials: GP
authors.lastname: Kurita
authors.affiliation: d Section of Palliative Medicine, Department of Oncology , Rigshospitalet, Copenhagen University Hospital , Denmark .|f Department of Clinical Medicine , Faculty of Health and Medical Sciences, University of Copenhagen , Denmark and.
authors.forename: Per
authors.initials: P
authors.lastname: Sjøgren
authors.affiliation: g Palliative Care, Pain Therapy and Rehabilitation Department , Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy on behalf of the European Palliative Care Research Collaborative (EPCRC).
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pigni
authors.affiliation: g Palliative Care, Pain Therapy and Rehabilitation Department , Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy on behalf of the European Palliative Care Research Collaborative (EPCRC).
authors.forename: Augusto
authors.initials: A
authors.lastname: Caraceni
mesh_terms: D001416:Back Pain / Q000601:surgery*; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D013131:Spine / Q000601:surgery*