Safety and Efficacy of Extensive Vertebroplasty (up to 6 Levels) for the Management of Painful Thoracolumbar Metastases

Objectives: To assess the safety and efficacy of extensive vertebroplasty (EV) for the management of painful, extensive thoracolumbar metastases. Methods: In this single-center retrospective study, we reviewed 50 consecutive patients treated using EV from 2015 to 2019 (at least six levels treated in a single session), for pain palliation, or need for decrease painkiller consumption. The primary endpoint was safety of the procedure, with report of complications according to the Clavien–Dindo classification and including clinically relevant cement pulmonary embolism. The secondary endpoints were back pain-related numeric rating scale (NRS) and daily opioid consumption comparison between preoperative and 4 weeks postoperative evaluation and occurrence of skeletal relative events (SREs). Results: A total of 397 vertebras were treated during 50 EV sessions (mean 7.9 ± 1.5 levels by session). The mean procedure duration was 162 ± 35 min, the mean postoperative hospitalization duration was 1.6 ± 0.9 days, and the mean follow-up duration was 401 ± 297 days. Seven complications were reported, without major complication (grade 4 or 5) according to the Clavien–Dindo classification. One patient had a symptomatic pulmonary cement embolism. There was a significant difference between pre- and postprocedure mean NRS score (5.0 ± 1.8 vs. 1.7 ± 1.4, P < 0.0001), with a mean score decrease of 3.3 points (62%), and between pre- and postprocedure mean opioid use (76 ± 42 mg/24 h vs. 45 ± 37 mg/24 h, P = 0.0003), with a mean decrease of 30 mg/24 h (33%). SRE occurred on seven patients during the follow-up. Conclusion: EV is safe and effective for the management of painful extensive spinal metastases.

Publication History

Article published online:
26 April 2021