Is balloon kyphoplasty safe and effective for cancer‐related vertebral compression fractures with posterior vertebral body wall defects?

Abstract

BKP can alleviate pain and improve QoL and function in patients with cancer-related VCFs with PVBW defects with no appreciable increase in risk. J. Surg. Oncol. 2016;113:835-842. © 2016 Wiley Periodicals, Inc.

The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG)

“…If one has concerns about the spinal stability because of a posterior wall defect or pedicle/facet joint/pars involvement, then a CT scan with sagittal and coronal reconstructions can be very helpful. Patients can have quite significant bony defects but still be structurally stable in an orthotic brace 80 . A brace may be all that is needed in patients with a spinal fracture if they can mobilise without significant pain.…”

Should kyphoplasty curettes be used in nonosteoporotic patients? A cautionary tale

“…Despite some arguments to the opposite, most spine surgeons would still consider a breach in the posterior wall of the vertebral body, especially if considering a pathological fracture with an associated tumoral lesion, at least a relative contraindication to kyphoplasty due to the fear of cement leakage toward the spinal canal as well as further posterior displacement of tumoral tissue and/or cortical bone with risk of new onset of neurological deficits …”

“…In fact, it has been estimated that the injection pressure is reduced by more than threefold by the creation of a cavity in the vertebral body before cement injection (average maximum intravertebral pressure in the group with void creation versus the one without void creation of 1.20 vs 5.09 kPa, P = .001). 14 Despite some arguments to the opposite, 15 most spine surgeons would still consider a breach in the posterior wall of the vertebral body, especially if considering a pathological fracture with an associated tumoral lesion, at least a relative contraindication to kyphoplasty due to the fear of cement leakage toward the spinal canal as well as further posterior displacement of tumoral tissue and/or cortical bone with risk of new onset of neurological deficits. 16 The use of curettes during kyphoplasty (a procedure to which we refer as cavitational kyphoplasty) 17 has emerged in the past few years as an interesting alternative for low-pressure cement injection while mitigating the possible associated risks of balloon inflation.Furthermore, there has been a growing amount of evidence suggesting that unilateral cement augmentation may provide similar benefits to a bilateral approach in terms of clinical outcomes, with lower operative times and radiation exposure.…”

State-of-the-art of minimally invasive treatments of bone metastases

“…4 shows a schematic diagram of PVP. The reliable safety and efficacy of PVP in the treatment of spinal metastases has been established beyond doubt; it has an overall efficiency of 60%–97% [25] , [32] , [33] , [34] , [35] , [36] , [37] , [38] . The most common complication of this technique is cement leakage, but the vast majority of these leaks are asymptomatic [36] , [39] .…”