Percutaneous Minimally Invasive Techniques in the Treatment of Spinal Metastases

Abstract

Spinal metastases are a common and morbid condition in America. Of the 1.6 million new cases of cancer estimated to be diagnosed in the USA in 2015, approximately 5-10 % will develop spinal metastases. This number is expected to increase as the life expectancy of cancer patients increases. Patients with osteolytic spinal metastases experience severe and often debilitating pain, which significantly reduces quality of life. Due to the morbidity of open surgery, particularly in oncologic patients, the treatment paradigm has shifted towards minimally invasive therapy. The advent and evolution of percutaneous treatments of spinal metastases has shown progressive success in reducing pain, improving function, and providing mechanical stability. There are various currently available interventions including vertebroplasty, vertebral augmentation, and coblation and radiofrequency ablation systems. For more complex spinal metastases, combined treatments including vertebral augmentation in conjunction with radiofrequency ablation, external beam radiation, and the novel treatment of intraoperative radiotherapy are also available. Ultimately, the goal of treatment in this patient population is palliative with the intention of improving the remaining quality of life. There is no established algorithm or specific technique that has proved best for the many variations of vertebral compression fractures (VCFs), so treatment tends to be dependent on the operator and/or based on institution preference or bias. Each technique provides its own unique value in the various types of metastatic VCFs encountered, and understanding the uses, advantages, and safety profile of each specific treatment is imperative in providing the best patient care. Percutaneous treatment of metastatic spinal disease is an excellent alternative to medical and surgical management in carefully selected patients. We believe that a multidisciplinary approach and combination therapy allows for optimal pain reduction and improvement of function.

Effects of surgery and radiofrequency ablation in the treatment of spinal metastases and analysis of the influencing factors of prognosis

“…The results of our study show that the time of operation and intraoperative blood loss of patients in the research group are significantly lower than those in the control group, which suggests that we can effectively reduce the time of operation and blood loss when radiofrequency ablation is used to assist surgery. Previous studies (19,20) have shown that one of the advantages of radiofrequency ablation is that it can coagulate tumor microvessels locally through thermal ablation, which is conducive to reducing the density of blood vessels and the amount of bleeding during surgery, and is also conducive to surgical operation so as to shorten the time of operation, which proves and explains our results. Then the VAS, KPS scores, and Frankel grading of patients in the two groups before and after surgery were compared.…”

Treatment of subacute osteoporotic vertebral compression fractures with percutaneous vertebroplasty: A case report

“…This may be the consequence of the greater stiffness of the vertebra filled with bone cement and altered biomechanics and the load transfer of the spine 11 . According to the others, these new fractures are not the side effect of the PVP, but the result of the further deterioration of the osteoporotic spine and reduction of bone mineral density 3,10,16 . In presented case, no complications were encountered.…”

“…The most of these fractures are asymptomatic, but even in this cases and especially in symptomatic ones, quality of life may be notably changed due to height loss, kyphosis, back pain, and lost selfconfidence regarding physical activities 2 . The conservative treatment including analgesic medications, rest and physical therapy is often ineffective on long-term basis, because of the persistent pain, decreased mobility and neurological complications 3,4 .…”

Circulating Tumour Cell Release after Cement Augmentation of Vertebral Metastases

“…Mechanical influences have long been suspected to enhance the release of viable tumour cells into the circulation 23 – 25 . With increasing numbers of long-term cancer survivors, 5–10% of cancer patients will develop spinal metastases during their disease course 26 . However, cancer metastases are still amenable to salvage therapy with a relatively good prognosis compared to earlier decades, especially in an metastatic setting where systemic metastatic spread is limited to one organ system, or even to a solitary metastasis 27 .…”

“…Cement augmentation due to VP or KP represents safe approaches to treat fractured and/or symptomatic spinal metastasis. Compared to an open surgical approach, serious complications are rarely seen in vertebroplasty and patients vastly benefit from the short procedure 16 , 26 . As quality of life can be improved in many cases, overall 81% of patients are satisfied with the treatment outcome 28 .…”