Download PDF
Minim Invasive Neurosurg 2008; 51(5): 280-284
DOI: 10.1055/s-0028-1082328
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Vertebroplasty in the Treatment of Pain Induced by Spinal Metastatic Tumor

Y.-Y. Tseng 1 , S.-T. Yang 1 , P.-H. Tu 1 , T.-C. Yang 1 , Y.-L. Lo 1
  • 1Department of Neurosurgery, Chang Gung Memorial Hospital & Chang Gung University, Taoyuan, Taiwan, ROC
Further Information

Publication History

Publication Date:
14 October 2008 (online)

    Permissions and Reprints

Abstract

Spinal metastatic tumor is a common problem and represents a challenging problem in oncology practice. Patients with osteolytic metastases often suffer from intractable local and/or radicular pain. Percutaneous vertebroplasty is a minimally invasive, radiologically guided procedure whereby bone cement is injected into structurally weakened vertebrae to provide immediate biomechanical stability. Vertebroplasty is also used to relieve pain by stabilizing metastatically compromised vertebrae that are at risk of pathological burst fracture. In this retrospective study, a total of 57 patients (78 vertebrae) with spinal metastatic tumor were treated with PMMA vertebroplasty. The mean value of the visual analogue scale (VAS) was 8.1±0.67 preoperatively, and significantly decreased to 3.8±1.9 (1–8, p<0.015) one day after vertebroplasty. The mean VAS value 6 months after vertebroplsty was 2.8±2.0 (p<0.001). Mean injected bone cement amount in our study is 5.16±1.6 mL. The complication rate is about 21.8%, bone cement extravasation without neurological deficit is the most common complication. No new or adjacent vertebral fracture has occurred in more than 2 years follow-up. Percutaneous vertebroplasty is a minimally invasive procedure that offers a remarkable advantage of effective and immediate pain relief with few complications.

Key words

vertebroplasty - spinal metastatic tumor - minimal invasive - spinal stability - PMMA - pain

References

  • 1 Bilsky MH. New therapeutics in spine metastases.  Expert Rev Neurother. 2005;  5 831-840
    CrossrefPubMedGoogle Scholar
  • 2 Aaron AD. The management of cancer metastatic to bone.  JAMA. 1994;  272 1206-1209
    CrossrefPubMedGoogle Scholar
  • 3 Barron KD, Hirano A, Araki S. et al . Experiences with metastatic neoplasms involving the spinal cord.  Neurology. 1959;  9 91-106
    CrossrefPubMedGoogle Scholar
  • 4 Schiff D, O’Neill BP, Suman VJ. Spinal epidural metastasis as the initial manifestation of malignancy: clinical features and diagnostic approach.  Neurology. 1997;  49 452-456
    CrossrefPubMedGoogle Scholar
  • 5 Gokaslan ZL, York JE, Walsh GL. et al . Transthoracic vertebrectomy for metastatic spinal tumors.  J Neurosurg. 1998;  89 599-609
    CrossrefPubMedGoogle Scholar
  • 6 Schiff D, O’Neill BP, Wang CH. et al . Neuroimaging and treatment implications of patients with multiple epidural spinal metastases.  Cancer. 1998;  83 1593-1601
    CrossrefPubMedGoogle Scholar
  • 7 Deramond H, Depriester C, Galibert P. et al . Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results.  Radiol Clin North Am. 1998;  36 533-546
    CrossrefPubMedGoogle Scholar
  • 8 Barr JD, Barr MS, Lemley TJ. et al . Percutaneous vertebroplasty for pain relief and spinal stabilization.  Spine. 2000;  25 923-928
    CrossrefPubMedGoogle Scholar
  • 9 Nicola N, Lins E. Vertebral hemangioma: retrograde embolization-stabilization with methyl methacrylate.  Surg Neurol. 1987;  27 481-486
    PubMedGoogle Scholar
  • 10 Binning MJ, Gottfried ON, Klimo Jr P. et al . Minimally invasive treatments for metastatic tumors of the spine.  Neurosurg Clin N Am. 2004;  15 459-465
    CrossrefPubMedGoogle Scholar
  • 11 Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy.  AJNR Am J Neuroradiol. 1994;  15 83-86
    PubMedGoogle Scholar
  • 12 Jensen ME, Evans AJ, Mathis JM. et al . Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects.  AJNR Am J Neuroradiol. 1997;  18 1897-1904
    PubMedGoogle Scholar
  • 13 Jensen ME, Kallmes DE. Percutaneous vertebroplasty in the treatment of malignant spine disease.  Cancer J. 2002;  8 194-206
    PubMedGoogle Scholar
  • 14 Weill A, Chiras J, Simon JM. et al . Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement.  Radiology. 1996;  199 241-247
    PubMedGoogle Scholar
  • 15 Genant HK, Wu CY, Kuijk C van. et al . Vertebral fracture assessment using a semiquantitative technique.  J Bone Miner Res. 1993;  8 1137-1148
    PubMedGoogle Scholar
  • 16 Alvarez L, Perez-Higueras A, Quinones D. et al . Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life.  Eur Spine J. 2003;  12 356-360
    CrossrefPubMedGoogle Scholar
  • 17 Cheung G, Chow E, Holden L. et al . Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: A prospective study using quality-of-life assessment.  Can Assoc Radiol J. 2006;  57 13-21
    PubMedGoogle Scholar
  • 18 Bilsky MH, Lis E, Raizer J. et al . The diagnosis and treatment of metastatic spinal tumor.  Oncologist. 1999;  4 459-469
    PubMedGoogle Scholar
  • 19 Bilsky MH, Boakye M, Collignon F. et al . Operative management of metastatic and malignant primary subaxial cervical tumors.  J Neurosurg Spine. 2005;  2 256-264
    PubMedGoogle Scholar
  • 20 Siddall PJ, Cousins MJ. Spinal pain mechanisms.  Spine. 1997;  22 98-104
    CrossrefPubMedGoogle Scholar
  • 21 Cortet B, Cotten A, Boutry N. et al . Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study.  J Rheumatol. 1999;  26 2222-2228
    Google Scholar
  • 22 Black P. Spinal metastasis: current status and recommended guidelines for management.  Neurosurgery. 1979;  5 726-746
    PubMedGoogle Scholar
  • 23 Ghogawala Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression.  Spine. 2001;  26 818-824
    CrossrefPubMedGoogle Scholar
  • 24 Barragan-Campos HM, Vallee JN, Lo D. et al . Percutaneous vertebroplasty for spinal metastases: complications.  Radiology. 2006;  238 354-362
    CrossrefPubMedGoogle Scholar
  • 25 Ahn H, Mousavi P, Chin L. et al . The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine.  Eur Spine J. 2007;  16 1171-1178
    CrossrefPubMedGoogle Scholar
  • 26 Belkoff SM, Mathis JM, Fenton DC. et al . An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture.  Spine. 2001;  26 151-156
    CrossrefPubMedGoogle Scholar
  • 27 Ahn H, Mousavi P, Roth S. et al . Stability of the metastatic spine pre and post vertebroplasty.  J Spinal Disord Tech. 2006;  19 178-182
    CrossrefPubMedGoogle Scholar
  • 28 Belkoff SM, Mathis JM, Jasper LE. et al . The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior.  Spine. 2001;  26 1537-1541
    CrossrefPubMedGoogle Scholar
  • 29 Panjabi MM, Thibodeau LL, Crisco 3rd JJ. et al . What constitutes spinal instability?.  Clin Neurosurg. 1988;  34 313-339
    PubMedGoogle Scholar
  • 30 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.  Spine. 1983;  8 817-831
    CrossrefPubMedGoogle Scholar
  • 31 Kostuik JP, Errico TJ, Gleason TF. et al . Spinal stabilization of vertebral column tumors.  Spine. 1988;  13 250-256
    CrossrefPubMedGoogle Scholar
  • 32 Farooq N, Park JC, Pollintine P. et al . Can vertebroplasty restore normal load-bearing to fractured vertebrae?.  Spine. 2005;  30 1723-1730
    CrossrefPubMedGoogle Scholar
  • 33 Chen HH, Wang WK, Li KC. et al . Biomechanical effects of the body augmenter for reconstruction of the vertebral body.  Spine. 2004;  29 E382-E387
    CrossrefPubMedGoogle Scholar
  • 34 Lindsay R, Silverman SL, Cooper C. et al . Risk of new vertebral fracture in the year following a fracture.  JAMA. 2001;  285 320-323
    CrossrefPubMedGoogle Scholar
  • 35 Berlemann U, Ferguson SJ, Nolte LP. et al . Adjacent vertebral failure after vertebroplasty. A biomechanical investigation.  J Bone Joint Surg [Br]. 2002;  84 748-752
    CrossrefPubMedGoogle Scholar
  • 36 Baroud G, Vant C, Wilcox R. Long-term effects of vertebroplasty: adjacent vertebral fractures.  J Long Term Eff Med Implants. 2006;  16 265-280
    PubMedGoogle Scholar

Correspondence

Y.-L. LoMD 

Department of Neurosurgery

Chang Gung Memorial Hospital

5 Fu-Shing Street 333

Kweishan

Taoyuan

Taiwan

ROC

Phone: +886/3/328 12 00 ext. 2119

Fax: +886/3/328 58 18

Email: britse17@gmail.com

      >