Vertebroplasty and Kyphoplasty
Advances in vertebroplasty and kyphoplasty for the treatment of metastatic spinal tumors without epidural compression have allowed surgeons to improve the anterior column stability of the spine in conjunction with medical and radiation therapies. In particular, these conservative procedures are beneficial for elderly patients at high risk because minimal blood loss occurs in addition to less operating time under anesthesia compared with their younger counterparts. Cement injection may provide structural support to the vertebral body. Thus, pain relief is achieved via mechanical stabilization. The most common complication is cement extravasation into the spinal canal, venous plexus, or both, and hematogenous embolization. A randomized, multicenter, controlled trial demonstrated the merits of kyphoplasty for patients with oncological vertebral compression fractures. The authors concluded that kyphoplasty is a safe, effective procedure that reduces pain, improves neurological function, and may be used in conjunction with posterior stabilization in cases of malignancy.
Vertebroplasty and kyphoplasty studies for the treatment of metastatic spinal tumors have demonstrated significant improvements in pain, mobility, and vertebral height restoration. Vertebroplasty studies specific to spinal metastases have demonstrated pain improvement among 73% to 100% of patients. Although few studies exist that have documented changes in mobility, McDonald et al observed an improvement in mobility among 70% of the 67 study participants. To our knowledge, Yang et al conducted the largest vertebroplasty study in patients with metastatic spinal disease. A total of 196 patients were treated during the study, and a 98.5% improvement in pain was seen, as well as statistically significant improvements in vertebral body height. Studies of kyphoplasty have demonstrated pain improvement in 81% to 100% of patients. To our knowledge, Berenson et al conducted the largest controlled, randomized multicenter study of kyphoplasty for spinal metastases. Of the 70 study participants, 65% had improved mobility and 81% had improved pain. The next most statistically powered study consisted of 50 patients, demonstrating a 96% rate of pain improvement. Newer combination treatment paradigms have also proven beneficial, as demonstrated by Gerszten et al. Twenty-six patients were successfully treated by kyphoplasty followed by CyberKnife spinal radiosurgery, and 92% saw an improvement in axial pain.