Open vertebroplasty in the treatment of spinal metastatic disease

Abstract

Background: Metastatic spine tumors can cause vertebral body (VB) osteolysis, microfractures, and/or compression fractures, and requires restabilization of the VB. Curative or curettage surgery, such as vertebrectomy and reconstruction, is currently the main method of treatment. In certain situations however, such as a patient's poor condition, multi-level involvement, or a limited life expiration, major surgery is not recommended.

Objective: To evaluate a new method of open vertebroplasty (OVP) in the treatment of VB metastasis and to investigate the indications for, limitations of, and the result of this new procedure.

Methods: Between May 2007 and May 2010, the authors treated 18 patients with VB metastasis disease by OVP. Patients consisted of 12 men and 6 women with a mean age of 53 years. All patients suffered severe back pain preoperatively (mean VAS score of 6.82). Spinal cord compression resulted in eight and isolated radicular compression occurred in three of the 18 patients. In these 18 patients, 28 vertebral levels were treated: three levels in 3 patients; two levels in 4 patients; and one level in the remaining 11 patients. OVP was used accompanied by vertebral fixation or medullary compression.

Results: The mean duration of the OVP procedure was 37 min. Blood loss ranged from 50 to 150 ml. In all patients, pain improved within seven days after the intervention, and the mean VAS score decreased to 2.31. Patients who suffered from neurological dysfunction preoperatively improved in Frankel degree (the result of spinal cord decompression). Most patients reached an excellent score, according to the Modified MacNab Criteria. Postoperative radiography revealed cement leaks into pulmonary veins in one case. After OVP or PVP, all patients underwent radiotherapy or chemotherapy.

Conclusions: OVP has a comprehensive application in metastasis spinal column disease, being easily performed and accompanied by few complications. Importantly, this procedure allows decompression of the spinal cord and consolidation of the VB, thus stabilizing the vertebral column. Results from the clinic demonstrate that patients experience pain relief and neural function recovery following the OVP procedure.