Percutaneous CT-Guided Vertebroplasty in the Management of Osteoporotic Fractures and Dorsolumbar Metastases

Pizzoli, Andrea; Brivio, L. Renzi; Caudana, Roberto; Vittorini, Enrico

doi:10.1016/j.ocl.2009.06.004

Cited by 16 publications

(8 citation statements)

References 29 publications

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“…Only recently, more complex MISS procedures, including endoscopy-assisted spinal cord decompression, tumor resection and spinal reconstruction through mini-open approaches, and percutaneous placement of pedicle screws, have been advocated as useful approaches for spinal metastases. 5,6,10,16,22,24,29,30 The goals with MISS are to achieve outcomes equivalent or superior to those of traditional open spine surgery and to reduce the impact of surgery in critical patients with poor general and neurological conditions with short-or mid-term life expectancy.…”

mentioning

confidence: 99%

Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results

Miscusi

Polli

Forcato

et al. 2015

SPI

104

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OBJECT Spinal metastasis is common in patients with cancer. About 70% of symptomatic lesions are found in the thoracic region of the spine, and cord compression presents as the initial symptom in 5%–10% of patients. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, with the aim of decreasing the morbidity associated with more traditional open spine surgery; furthermore, the recovery time is reduced after MISS, such that postoperative chemotherapy and radiotherapy can begin sooner. METHODS Two series of oncological patients, who presented with acute myelopathy due to vertebral thoracic metastases, were compared in this study. Patients with complete paraplegia for more than 24 hours and with a modified Bauer score greater than 2 were excluded from the study. The first group (n = 23) comprised patients who were prospectively enrolled from May 2010 to September 2013, and who were treated with minimally invasive laminotomy/laminectomy and percutaneous stabilization. The second group (n = 19) comprised patients from whom data were retrospectively collected before May 2010, and who had been treated with laminectomy and stabilization with traditional open surgery. Patient groups were similar regarding general characteristics and neurological impairment. Results were analyzed in terms of neurological recovery (American Spinal Injury Association grade), complications, pain relief (visual analog scale), and quality of life (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and EORTC QLQ-BM22 scales) at the 30-day follow-up. Operation time, postoperative duration of bed rest, duration of hospitalization, intraoperative blood loss, and the need and length of postoperative opioid administration were also evaluated. RESULTS There were no significant differences between the 2 groups in terms of neurological recovery and complications. Nevertheless, the MISS group showed a clear and significant improvement in terms of blood loss, operation time, and bed rest length, which is associated with a more rapid functional recovery and discharge from the hospital. Postoperative pain and the need for opioid administration were also significantly less pronounced in the MISS group. Results from the EORTC QLQ-C30 and QLQ-BM22 scales showed a more pronounced improvement in quality of life at follow-up in the MISS group. CONCLUSIONS In the authors' opinion, MISS techniques should be considered the first choice for the treatment for patients with spinal metastasis and myelopathy. MISS is as safe and effective for spinal cord decompression and spine fixation as traditional surgery, and it also reduces the impact of surgery in critical patients. However, further studies are needed to confirm these findings.

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mentioning

confidence: 99%

Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results

Miscusi

Polli

Forcato

et al. 2015

SPI

104

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“…Thus, the present study employed a technique in which balloon inflation, bone cement injection volume, and procedural timing was carefully controlled during surgery to prevent posterior cortex injury to the vertebral body. Previously, it has also been reported that CT guidance could significantly improve PKP outcomes and reduce complications, including cement leakage [29]. Thus, the present study used these best-practice techniques, demonstrating that current limitations of PKP surgery may be due to technical failures by the operator rather than inappropriateness of the PKP intervention per se .…”

Section: Discussionmentioning

confidence: 65%

A preliminary study of the safety and efficacy of radiofrequency ablation with percutaneous kyphoplasty for thoracolumbar vertebral metastatic tumor treatment

Cai

2014

Med Sci Monit

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BackgroundThoracolumbar vertebral metastasis (TVM) affects a large number of cancer patients. However, safe and effective palliative care remains controversial. The aim of the present study was to investigate the safety and efficacy of minimally invasive image-guided radiofrequency ablation (RFA) with percutaneous kyphoplasty (PKP) for TVM treatment.Material/MethodsA retrospective study of 26 patients (mean age: 59.31±11.62 years) was conducted, including 38 vertebral metastases at T11, T12, L1, L2, L3, L4, L5, and S1 with abundant blood vessels. Patients underwent RFA with PKP (4–6 min, 95±5°C, 150 W, effective electrode area of 1.5–2.0 cm) under general anesthesia from February 2005 to January 2009. Electrodes were inserted into the lesions and pre- and post-operative visual analog scale (VAS) scores and X-rays were collected on day 3, week 1, and months 1, 3, and 6. Tumor recurrence and pain level were also evaluated. Safety assessment was conducted based on complications and adverse events. The mean follow-up time was 8.4±2.1 months.ResultsA mean of 2.69±0.93 ablation was performed per patient. The ablation procedure required a mean of 15.08±4.64 min, while the injection of bone cement required a mean of 6.73±0.83 min, for a mean total operating time of 47.77±7.13 min. Postoperative VAS scores were significantly lower on day 3, week 1, and months 1, 3, and 6 (P<0.01), without any complications or tumor recurrence.ConclusionsImage-guided RFA with PKP was safe and effective for TVM treatment when used with careful consideration of bone cement volume/viscosity, injection location, and temperature.

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“…Pizzoli et al 26 published a series with 182 vertebroplasties performed on 106 patients, 67 with osteoporotic vertebral fractures and 39 with metastases. The patients with osteoporosis underwent 120 PVs, 77.5% of which were in the lumbar spine.…”

Section: A B Resultsmentioning

confidence: 99%

Treatment of vertebral pathological fractures by percutaneous vertebroplasty

Macedo¹,

Linhares²

2014

Coluna/Columna

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Objective: To evaluate a consecutive series of patients undergoing vertebroplasty for pain control, according to results and complications in the short and medium follow-up. Methods: Retrospective analysis of medical records of 26 patients undergoing vertebroplasty from January 2007 to December 2010. Patients were evaluated by the questionnaire of assessment of low back pain (Oswestry Index) and the visual analog pain scale (VAS) on the day before surgery, on the second day and 12 months after the procedure. Results: Significant improvement of pain symptoms within 48 hours after surgery was reported in 22 patients (91.6%), two patients (8.32%) showed moderate improvement. Of the 22 patients with significant pain relief, 21 (95.4%) maintained the benefit and one (4.6%) had intense pain (new fracture in the body of L1) at a mean follow up of 12 months. Regarding the Oswestry Index, preoperative average was 52.9%. On the second day and 12 months after surgery this average was 23.6% and 24.5%, respectively; good results according to this index. Two patients were excluded from the study due to incomplete medical records. Conclusion: Despite the small sample size and short follow-up, the results of vertebroplasty were effective for the relief of pain symptoms and were safe as regards the risks of complications.Keywords: Low back pain; Spinal fractures; Osteoporosis; Vertebroplasty; Retrospective studies.

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Percutaneous CT-Guided Vertebroplasty in the Management of Osteoporotic Fractures and Dorsolumbar Metastases

Cited by 16 publications

References 29 publications

Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results

Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results

A preliminary study of the safety and efficacy of radiofrequency ablation with percutaneous kyphoplasty for thoracolumbar vertebral metastatic tumor treatment

Treatment of vertebral pathological fractures by percutaneous vertebroplasty

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