Percutaneous vertebroplasty as treatment of malignant vertebral lesions: a systematic review and GRADE evaluation resulting in a Danish national clinical guideline

Abstract

Purpose To summarize the recommendations from the national clinical guideline published by the Danish Health Authority, regarding cemental augmentation as treatment for painful vertebral lesions, in patients with malignant disease. Methods A multidisciplinary working group formulated recommendations based on the GRADE approach. Results Two of the questions were based on randomized studies and one on professional consensus. The guideline recommends cemental augmentation for painful vertebral lesions in patients with malignant diagnosis, either hematological or non-hematological. Fracture of the posterior wall is not a contradiction to cemental augmentation, but care should always be taken while injecting the cement, to decrease the risk of cemental leaks into the spinal canal. Conclusion The recommendations are based on low-to-moderate quality of evidence or professional consensus as well as patient preferences and positive and harmful effects of the intervention. The working group recommends more randomized studies on patients with different malignant diseases and painful vertebral lesions comparing percutaneous vertebroplasty/ kyphoplasty and conservative treatment to confirm the conclusion in this guideline. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.

Multiple Myeloma Associated Bone Disease

“…A retrospective analysis, with 18 myeloma patients who underwent vertebroplasty prior to autologous stem cell transplant showed that vertebroplasty could be done without affecting peripheral blood stem cell collection and transplant [109]. The current recommendation in myeloma associated vertebral collapse is to consider vertebral augmentation if it causes moderate or severe pain, and particularly if it affects mobilization [110] This is supported by a recently published national guideline based on the GRADE-approach [111] recommending vertebral augmentation as treatment in patients with painful vertebral lesions and malignant hematologic disease [112].…”

Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors

“…Additionally, the cement consolidates and stabilizes fractured fragments and prevents further vertebral body collapse 7 . Vertebroplasty is recommended by several adult medical societies for the palliative treatment of painful oncologic fractures or weakened vertebral bodies secondary to neoplasms, with a reported clinical success of 92% and major complication rate < 1% [24][25][26][27][28][29] . Vertebroplasty can be performed under conscious sedation or general anesthesia and takes approximately 15-30 minutes, with an increment of 5-15 minutes for any additional vertebral level treated 7 .…”

Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors

“…Additionally, the cement consolidates and stabilizes fractured fragments and prevents further vertebral body collapse 16 . Vertebroplasty is recommended by several adult medical societies for the palliative treatment of painful oncologic fractures or weakened vertebral bodies secondary to neoplasms, with a reported clinical success of 92% and major complication rate <1% 17–22 …”

“…16 Vertebroplasty is recommended by several adult medical societies for the palliative treatment of painful oncologic fractures or weakened vertebral bodies secondary to neoplasms, with a reported clinical success of 92% and major complication rate <1%. [17][18][19][20][21][22] The procedure is associated with significant pain reduction and increase in the level of function, with sustained long-term benefit.…”