Long-term benifts of percutaneous anatomical restoration of vertebral compression fractures linked to malignancy

Abstract

ABSTRACTwill develop spine symptoms, and approximately 40% to 70% of these patients will have multiple-level involvement (1,28,34).The development of VCF associated with malignancy deteriorates quality of life and increases pain, sagittal imbalance and abdominal and respiratory problems (2, 41). All of these symptoms are of great importance when dealing with the osteoporotic population (18) and are even more relevant for the cancer population (13,19,20,22,33). █ INTRODUCTIONSpine disease due to malignant lesions is common among cancer patients. The incidence of spine malignant disease varies from 30% to 70%, depending on the primary tumor (14, 30), although not all of these cases are symptomatic. The incidence of vertebral compression fracture (VCF) in multiple myeloma is 24%, 14% in breast cancer and 6% among prostate cancer. Approximately 10% of lung cancer patients AIM: To evaluate the efficacy, feasibility and safety of a percutaneous anatomical vertebral body reduction for the treatment of VCF (vertebral compression fracture) linked to malignancy. Vertebroplasty and percutaneous kyphoplasty have played essential roles in the treatment of painful vertebral metastasis, although there are few reports with long survival that have evaluated the long-term efficacy, adjacent fractures and vertebral body (VB) re-collapse associated with these procedures. We aimed to evaluate the longterm efficacy and the complications associated with malignancy and changes in spinal biomechanics. MATERIAL and METHODS:The retrospective study examined 32 patients with osteolytic VCF due to malignant infiltration of the vertebral body. A visual analogue scale, the EQ5 and radiological analysis (i.e., X-ray and CT scan) were used to assess back pain, quality of life and complications.RESULTS: Statistically significant reductions in anterior and central vertebral body heights (6.2 mm-19.6 ± 4.2 mm-and 5.8 mm-16.7 ± 7.8 mm-, respectively) that resulted in reductions of the regional Cobb angles exceeding 30% were observed. There was also a statistically significant improvement in quality of life. The average survival was longer than those reported in most published articles, and the average follow-up period was 30.9 months. CONCLUSION:Anatomical restoration (i.e., cortical ring reduction with endplate rebalancing) is potentially beneficial for a wellselected group of patients with spine metastases and long life expectancies because this procedure avoids the complications typical of these types of treatments (e.g., leakage, adjacent fractures and re-collapse).

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures

“…A meta-analysis found improvements in pain intensity, vertebral height, sagittal alignment, functional capacity, and quality of life with BK as compared with conventional medical management [75]. Multiple other studies demonstrated the benefit of VA for alignment with improvement in pain relief [19,[76][77][78], and respiratory function [79][80][81]. In a multisociety position statement, it was concluded that VA of osteoporotic VCF is clearly beneficial in the short term and likely beneficial also in the long term [33].…”

Predictor of neurological function after surgical treatment of the metastatic epidural spinal cord compression

“…A non-surgical treatment of the spine metastasis shown to be effective in pain management in patients without neurological impairment. Preserving neurological function required surgical decompression and spine stabilization [16]. Surgical treatment is indicated in patients with survival prognosis more than 6 mouth.…”

“…Wimberg et al assessed the 7 most popular scales used to select optimum therapy [18]. Slow growing tumor, lack of visceral metastasis, better functional status reflected as by a higher score on SF-36 questionnaire have been identified to be predictor of longer survival [9,16,19].…”

Percutaneous Vertebroplasty of malignant lesions of the thoracolumbar spine: analysis of treatment results

“…However non-surgical modalities not provide sufficient support to maintain spine stability after VCF. A collapse of the vertebral body after VCF increased kyphotic deformation of the spine [9,10]. The kyphotic deformation of the spinal column led to decrease of the lung capacity, physical and social function of patients, diminishing quality of life [11].…”

“…Additional VP can be performed as a complement to radiotherapy and provide immediate vertebral stabilization [9][10][11][12][13].…”