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Madani K, Najafi A, Boticella A, Roux C, Tselikas L, Delpla A, Al Ahmar M, de Baere T, Deschamps F. Combined local treatments for vertebral metastases with limited epidural extension. Support Care Cancer 2021; 30:337-345. [PMID: 34287688 DOI: 10.1007/s00520-021-06443-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Vertebral metastases with limited epidural extension (VMLEE) are frequently encountered in cancer patients; they can cause severe and debilitating symptoms including pain and neurological impairment and are usually treated by radiotherapy. In this study, we mainly evaluated the safety of combined local treatments (CLT), associating radiofrequency ablation (RFA) with vertebroplasty and radiotherapy (RT) to treat VMLEE. Also, we aimed to evaluate the short-term efficacy of CLT on bone metastases palliation and long-term prevention of skeletal-related events. METHODS We retrospectively reviewed treatment complications, pain palliation, and skeletal complications after combined local treatments (CLT) for vertebral metastasis with limited epidural extension (VMLEE). RESULTS Eighteen consecutive patients had CLT for 24 VMLEE, between June 2016 and January 2021. No major post-treatment complication was recorded. Nine patients had pain before the initiation of CLT. One month after CLT, only 3 patients had residual pain with a significant decrease of visual analogue scale (VAS), from 7.3 ± 2.4 to 2 ± 0 (p = .008), as well as the mean morphine milligram equivalent dose from 196.6 ± 135.7 to 38.5 ± 26, p = .008. Mean follow-up was 16.7 ± 11.5 months. Only one vertebra showed an increase of a preexisting vertebral fracture. Nine VMLEE had evidence of residual disease, including 2 which resulted in spinal cord compression (2, 11 months). CONCLUSION CLT was safe and effective for pain palliation and long-term prevention of skeletal-related events for treatment of patients with VMLEE. The effectiveness of this combined treatment on tumor control and epidural involvement on the long term needs further investigation.
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Affiliation(s)
- Khaled Madani
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France.
| | - Arash Najafi
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Angela Boticella
- Department of Radiation Therapy, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Charles Roux
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Alexandre Delpla
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Marc Al Ahmar
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Frédéric Deschamps
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France.
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Wang M, Jin Q. High-viscosity bone cement for vertebral compression fractures: a prospective study on intravertebral diffusion and leakage of bone cement. BMC Musculoskelet Disord 2020; 21:589. [PMID: 32878606 PMCID: PMC7469425 DOI: 10.1186/s12891-020-03613-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background Bone cement leakage causes severe complication following percutaneous vertebroplasty. This study probed the diffusion and leakage status of bone cement injected within diverged time duration, so as to find the optimal injection time for bone cement. Methods A total of 70 patients with osteoporotic vertebral compression fractures with a symptom of low back pain, who underwent treatment at hospital were enrolled in this study. Patients were randomized into three groups: < 180 s, 180–300, and > 300 s of injection time duration from the beginning to the completion of the injection. The scenarios of vertebral bone cement leakage and diffusion were inspected using postoperative CT. Results The diffusion coefficient was higher in group A than in group B whereas it was higher in group B than in group C, but without statistical significance among the three groups. The leakage rate was without statistical significance among the three groups. The injection time of bone cement was negatively correlated with the diffusion coefficient, at the correlation coefficient of − 0.253. Conclusions The diffusion coefficient of high-viscosity bone cement is negatively correlated with the injection time, and the leakage rate of high-viscosity bone cement does not reduce with the prolongation of injection time.
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Affiliation(s)
- Meiyong Wang
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.,The third staff Hospital of Baogang group, 014010, Baotou, Inner Mongolia Autonomous Region, China
| | - Qunhua Jin
- General hospital of Ningxia Medical University, Yinchuan, China.
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Delpla A, Tselikas L, De Baere T, Laurent S, Mezaib K, Barat M, Nguimbous O, Prudhomme C, Al-Hamar M, Moulin B, Deschamps F. Preventive Vertebroplasty for Long-Term Consolidation of Vertebral Metastases. Cardiovasc Intervent Radiol 2019; 42:1726-1737. [PMID: 31444627 DOI: 10.1007/s00270-019-02314-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION To evaluate the long-term consolidation of vertebral metastases (VM) after preventive vertebroplasty (PV) and to report risk factors of pathological fracture despite PV. MATERIALS AND METHODS Files of 100 consecutives cancer patients referred for PV of VM were retrospectively analyzed. We enumerated 215 VM at the time of the PV procedure (T0): 138 VM were considered at risk of pathological fracture and had PV (treated-VM), and 77 VM were not cemented. We compared the VM characteristics using the spine instability neoplastic score (SINS) at T0 and the rate of pathologic fracture between treated-VM and untreated-VM using Kaplan-Meier method. We analyzed risk factors of pathological fracture despite PV using treated-VM characteristics and quality of cement injection criteria. RESULTS Despite a lower SINS value at T0 (p < 0.001), the rate of pathological fracture was significantly higher among untreated-VM compared to the treated-VM, (log-rank, p < 0.001). Major risk factors of fracture among treated-VM were: SINS value ≥ 8 (p < 0.012), mechanical pain (p = 0.001), osteolytic lesion (p = 0.033), metastatic vertebral body involvement > 50% with no collapse (p < 0.001) and unilateral posterior involvement by the vertebral metastasis (p = 0.024), Saliou score < 9 (p = 0.008), vertebral metastasis filling with cement < 50% (p = 0.007) and the absence of cement's contact with vertebral endplates (p = 0.014). CONCLUSION PV is long-term effective for consolidation of VM and must be discussed at the early diagnosed. Quality of cement injection matters, suggesting that techniques that improve the quantity and the quality of cement diffusion into the VM must be developed.
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Affiliation(s)
- Alexandre Delpla
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France.
- Paris-Sud, Le Kremlin Bicêtre, France.
| | - Lambros Tselikas
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Thierry De Baere
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Sophie Laurent
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Karima Mezaib
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Maxime Barat
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Olivia Nguimbous
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Clara Prudhomme
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Marc Al-Hamar
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Benjamin Moulin
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
| | - Frederic Deschamps
- Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
- Paris-Sud, Le Kremlin Bicêtre, France
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Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization. Spine J 2019; 19:131-143. [PMID: 29890263 DOI: 10.1016/j.spinee.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vertebral body hemangiomas with myelopathy are difficult to manage. OBJECTIVE The objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). CLINICAL MATERIALS AND METHODS This prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS The study included 33 patients (mean 26.9±13.2, range: 10-68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28-103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. CONCLUSIONS This is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.
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Borgström F, Beall DP, Berven S, Boonen S, Christie S, Kallmes DF, Kanis JA, Olafsson G, Singer AJ, Åkesson K. Health economic aspects of vertebral augmentation procedures. Osteoporos Int 2015; 26:1239-49. [PMID: 25381046 DOI: 10.1007/s00198-014-2953-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 10/27/2014] [Indexed: 01/17/2023]
Abstract
We reviewed all peer-reviewed papers analysing the cost-effectiveness of vertebroplasty and balloon kyphoplasty for osteoporotic vertebral compression fractures. In general, the procedures appear to be cost effective but are very dependent upon model input details. Better data, rather than new models, are needed to answer outstanding questions. Vertebral augmentation procedures (VAPs), including vertebroplasty (VP) and balloon kyphoplasty (BKP), seek to stabilise fractured vertebral bodies and reduce pain. The aim of this paper is to review current literature on the cost-effectiveness of VAPs as well as to discuss the challenges for economic evaluation in this research area. A systematic literature search was conducted to identify existing published studies on the cost-effectiveness of VAPs in patients with osteoporosis. Only peer-reviewed published articles that fulfilled the criteria of being regarded as full economic evaluations including both morbidity and mortality in the outcome measure in the form of quality-adjusted life years (QALYs) were included. The search identified 949 studies, of which four (0.4 %) were identified as relevant with one study added later. The reviewed studies differed widely in terms of study design, modelling framework and data used, yielding different results and conclusions regarding the cost-effectiveness of VAPs. Three out of five studies indicated in the base case results that VAPs were cost effective compared to non-surgical management (NSM). The five main factors that drove the variations in the cost-effectiveness between the studies were time horizon, quality of life effect of treatment, offset time of the treatment effect, reduced number of bed days associated with VAPs and mortality benefit with treatment. The cost-effectiveness of VAPs is uncertain. In answering the remaining questions, new cost-effectiveness analysis will yield limited benefit. Rather, studies that can reduce the uncertainty in the underlying data, especially regarding the long-term clinical outcomes of VAPs, should be conducted.
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Roedel B, Clarençon F, Touraine S, Cormier E, Molet-Benhamou L, Le Jean L, Brisse H, Neuenschwander S, Chiras J. Has the percutaneous vertebroplasty a role to prevent progression or local recurrence in spinal metastases of breast cancer? J Neuroradiol 2014; 42:222-8. [PMID: 24998599 DOI: 10.1016/j.neurad.2014.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of percutaneous vertebroplasty (PV) on the prevention of progression or local recurrence in patients with spinal metastases from breast cancer. MATERIALS AND METHODS Retrospective study on 55 patients between 27-78 years of age (mean age: 55 years) treated for metastatic breast cancer in the same institution (Curie institute, Paris, France), who underwent percutaneous vertebroplasty (PV) (number of vertebrae treated=137) for spinal metastases from January 2000 to December 2009 at the Pitié-Salpêtrière hospital. Statistical correlation between the local tumor progression/recurrence, and the presence of an epidural or a paravertebral metastatic extension at diagnosis, the rate of cement filling the lesion (<50%, ≥50% but incomplete, complete/almost complete) and radiotherapy was evaluated using Chi(2) and Fisher's exact test. RESULTS The rate of local tumor progression/recurrence of the vertebrae treated by vertebroplasty was 14% (19/137). No statistically significant correlation between either the rate of cement filling of the lesion, or the presence of an epidural or paravertebral metastatic extension, and progression/local recurrence after vertebroplasty was found. No influence of radiotherapy in preventing local progression/recurrence was noted. Distant new bone metastases were observed in 47 out of 55 patients (86%). CONCLUSION The low rate of local tumor progression/recurrence after a vertebroplasty may support the hypothesis of an antitumor effect of the cement.
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Affiliation(s)
- Beatriz Roedel
- Department of Neuroradiology, Pitié-Salpêtrière hospital, Paris VI University, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière hospital, Paris VI University, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | | | - Evelyne Cormier
- Department of Neuroradiology, Pitié-Salpêtrière hospital, Paris VI University, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Luc Molet-Benhamou
- Department of Neuroradiology, Pitié-Salpêtrière hospital, Paris VI University, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - Lise Le Jean
- Department of anesthesiology, Pitié-Salpêtrière hospital, Paris, France
| | - Hervé Brisse
- Department of Radiology, Institut Curie, Paris, France
| | | | - Jacques Chiras
- Department of Neuroradiology, Pitié-Salpêtrière hospital, Paris VI University, 47, boulevard de l'Hôpital, 75013 Paris, France
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Josten C, Schmidt C, Spiegl U. [Osteoporotic vertebral body fractures of the thoracolumbar spine. Diagnostics and therapeutic strategies]. Chirurg 2013; 83:866-74. [PMID: 23051984 DOI: 10.1007/s00104-012-2338-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In cases of severe osteoporosis vertebral body fractures of the thoracolumbar spine can occur without any relevant trauma. Initially, a standardized diagnostic algorithm is recommended to detect acute vertebral body fractures and to be able to interpret the individual fracture stability. Aim of the therapy is to assure a relatively pain-free mobilization while maintaining vertebral spine alignment. A conservative therapy concept is initiated in patients with stable fractures. In cases of persistent pain, reduced mobility or increased kyphotic misalignment minimally invasive cement augmented therapy strategies are chosen. In cases of unstable fracture morphology a more complex therapy concept has to be chosen such as hybrid stabilization. A great deal of experience is needed for revision surgery. In such cases reconstructive, multi-segmental techniques might be necessary and the instrumentation should surpass the apex of kyphosis.
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Affiliation(s)
- C Josten
- Klinik und Poliklinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Wirbelsäulenzentrum, Universitätsklinik Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Wilson DJ, Owen S, Corkill RA. Facet joint injections as a means of reducing the need for vertebroplasty in insufficiency fractures of the spine. Eur Radiol 2011; 21:1772-8. [PMID: 21487701 DOI: 10.1007/s00330-011-2115-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/14/2011] [Accepted: 03/23/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Recent publications compared treatment of vertebral fractures reporting improvement in the majority but with no significant difference between the local anaesthetic and vertebroplasty groups. Potential explanations include placebo response or therapeutic response to the "control procedure". We investigated whether preliminary facet joint injection can identify those patients whose pain arises from paravertebral structures rather than the vertebral insufficiency fracture itself. METHODS Patients referred for treatment by vertebroplasty were first offered local anaesthetic and steroid facet joint injection (FJI) at the most painful level. Those who failed to respond were offered a vertebroplasty. RESULTS Ninety one patients referred, 16 went straight to vertebroplasty. Sixty one of 75 were initially offered FJI. Twenty one were successful; two relapsed, had further FJIs with good results; three declined treatment; 5 had temporary benefit; 1 died from unrelated causes. Of 29 who failed to respond to FJIs, 24 underwent vertebroplasty and 23 had a successful outcome. CONCLUSIONS A third of patients technically suitable for vertebroplasty responded beneficially to FJI. In this group the pain mediator maybe one of instability and overload on the facet joints produced by adjacent wedge fracture. This protocol allows more selective and more successful vertebroplasty.
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Affiliation(s)
- David J Wilson
- Nuffield Orthopaedic Centre NHS Trust, Oxford, OX3 7LD, UK.
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Amoretti N, Lesbats-Jacquot V, Marcy PY, Hauger O, Maratos Y, Ianessi A, Amoretti ME. [Vertebroplasty and kyphoplasty under dual guidance (CT and fluoroscopy): radiation dose to radiologist. A comparative study]. J Neuroradiol 2011; 38:135-40. [PMID: 21227508 DOI: 10.1016/j.neurad.2010.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 09/26/2010] [Accepted: 10/01/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goals of this study is to evaluate and compare the irradiation received by the practitioner when performing percutaneous vertebroplasty or kyphoplasty guided by CT and fluoroscopy, for precise anatomical sites. METHODS For each intervention, radiothermoluminescent dosimeters were carefully positioned on both orbitals, both hands, and both ankles of the practitioner. RESULTS Twenty-four vertebroplasties were performed in 18 patients and nine kyphoplasties on seven patients. The anatomical site that is most exposed to radiation is the right hand. The two other sites subjected to irradiation are the left hand and the left orbital. This study demonstrates a significant correlation between the irradiation dose and fluoroscopy duration, reflecting both the quantity of primary-beam radiation and backscattered radiation. CONCLUSION The radiation dose to radiologist is more important for kyphoplasty procedures than vertebroplasty.
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Affiliation(s)
- N Amoretti
- Radiology department, CHU de Nice, 06200 Nice, France.
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