Vertebroplasty and kyphoplasty for spinal metastases.
Curr Opin Support Palliat Care. 2008 Mar;2(1):9-13
Authors: Chi JH, Gokaslan ZL
PURPOSE OF REVIEW: Pathologic fractures of the spine are extremely painful and cause significant disability and morbidity in patients suffering from metastatic cancer. Often, these patients are not candidates for open surgical procedures and cannot address mechanical instability and radiation therapy can take weeks to become effective. Minimally invasive surgical techniques have been developed over the past several years, offering a simple and effective way of managing painful pathologic fractures. RECENT FINDINGS: Vertebroplasty and kyphoplasty offer patients a minimally invasive, percutaneous procedure that dramatically reduces pain related to pathologic spinal fractures almost immediately with very low complication rates. Visual analog scale pain scores, narcotic usage and quality of life scales (SF-36) have all been shown to improve in a durable fashion for over 1 year. Also, these procedures can be performed before, after or concurrently with most radiation and chemotherapy protocols. SUMMARY: We recommend vertebroplasty or kyphoplasty in properly selected patients with painful pathologic fractures as early as possible. Newer biomaterials, which are softer than currently used cement, may offer better protection from adjacent level fracturing and lower complication rates.
PMID: 18685387 [PubMed - indexed for MEDLINE]
But which do you prefer, vertebroplasty with no additional pressure or Kyphoplasty with space occupying pressure which may displace mets to canal with compromise? How about thermoablation first with “spine wand” before plasty?
I don’t know of data to support the approach, but it may be interesting to consider prognostic schemas such as the Tokuhashi score[ http://www.ncbi.nlm.nih.gov/pubmed/1702559 and http://www.ncbi.nlm.nih.gov/pubmed/18981960 ] to select a subgroup whose overall prognosis would not suggest a high likelihood of going on to develop symptomatic canal compromise from kyphoplasty.