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Wu L, Hu M, Li P, Man Q, Yuan Q, Zhang X, Qiu Y, Chen L, Fan J, Zhang K. Microwave ablation combined with percutaneous vertebroplasty for treating painful non-small cell lung cancer with spinal metastases under real-time temperature monitoring. J Cancer Res Ther 2024; 20:540-546. [PMID: 38687923 DOI: 10.4103/jcrt.jcrt_1074_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024]
Abstract
PURPOSE To retrospectively study the therapeutic effect and safety performance of the combination strategies of the computed tomography (CT)-guided microwave ablation (MWA) and percutaneous vertebroplasty (PVP) as a treatment for painful non-small cell lung cancer (NSCLC) with spinal metastases. MATERIALS AND METHODS A retrospective review included 71 patients with 109 vertebral metastases who underwent microwave ablation combined with percutaneous vertebroplasty by the image-guided and real-time temperature monitoring. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry Disability Index (ODI) scores before treatment and during the follow-up period. RESULTS Technical success was achieved in all patients. The mean pre-procedure VAS score and morphine doses were 6.6 ± 1.8 (4-10) and 137.2 ± 38.7 (40-200) mg, respectively. The mean VAS scores and daily morphine doses at 24 h and 1, 4, 12, and 24 weeks postoperatively were 3.3 ± 1.9 and 73.5 ± 39.4 mg; 2.2 ± 1.5 and 40.2 ± 29.8 mg; 1.7 ± 1.2 and 31.3 ± 23.6 mg; 1.4 ± 1.1 and 27.3 ± 21.4 mg; and 1.3 ± 1.1 and 24.8 ± 21.0 mg, respectively (all P < 0.001). ODI scores significantly decreased (P < 0.05). Minor cement leakage occurred in 51 cases (46.8%), with one patient having a grade 3 neural injury. No local tumor progression was observed by follow-up imaging. CONCLUSIONS MWA combined with PVP can significantly relieve pain and improve patients' quality of life, which implied this is an effective treatment option for painful NSCLC with spinal metastases. Additionally, its efficacy should be further verified through the mid- and long-term studies.
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Affiliation(s)
- Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital Affiliated Xuzhou Medical University, Tengzhou City, Shandong Province, China
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Chen AL, Sagoo NS, Vannabouathong C, Reddy Y, Deme S, Patibandla S, Passias PG, Vira S. Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100317. [PMID: 38510810 PMCID: PMC10950794 DOI: 10.1016/j.xnsj.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Background The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) and vertebral cement augmentation (VCA) are 2 less invasive modalities compared to open surgery that have emerged as promising strategies, offering the potential for both pain relief and preservation of vertebral stability. The utility of these approaches, however, remains uncertain and subject to ongoing investigation.This systematic review and meta-analysis evaluates the available evidence and synthesize the results of studies that have investigated the combination of RFA and VCA for the treatment of spinal metastases, with the goal of providing a comprehensive and up-to-date assessment of the efficacy and safety of this therapeutic approach. Methods A literature search was conducted using the electronic databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from their inception to May 4th, 2022 in accordance with PRISMA guidelines. Studies were included if they met the following criteria: 1) spine metastases treated with RFA in combination with VCA, 2) available data on at least one outcome (i.e., pain palliation, complications, local tumor control), 3) prospective or retrospective studies with at least 10 patients, and 4) English language. Meta-analyses were conducted in R (R Foundation for Statistical Computing; Vienna, Austria), using the meta package. Results In the 25 included studies, a total of 947 patients (females=53.9%) underwent RFA + VCA for spinal metastatic tumors. Out of 1,163 metastatic lesions, the majority were located in the lumbar region (585/1,163 [50.3%]) followed by thoracic (519/1,163 [44.6%]), sacrum (39/1,163 [3.4%]), and cervical (2/1,163 [0.2%]). 48/72 [66.7%] metastatic lesions expanded into the posterior elements. Preoperative pathologic vertebral fractures were identified in 115/176 [65.3%] patients. Between pre-procedure pain scores and postprocedure pain scores, average follow-up (FU) was 4.41±2.87 months. Pain scores improved significantly at a short-term FU (1-6 months), with a pooled mean difference (MD) from baseline of 4.82 (95% CI, 4.48-5.16). The overall local tumor progression (LTP) rate at short-term FU (1-6 months) was 5% (95% CI, 1%-8%), at mid-term FU (6-12 months) was 22% (95% CI, 0%-48%), and at long-term FU (>12 months) was 5% (95% CI, 0%-11%). The pooled incidence of total complications was 1% (95% CI, 0%-1%), the most frequent of which were transient radicular pain and asymptomatic cement extravasation. Conclusions The findings of this meta-analysis reveal that the implementation of RFA in conjunction with VCA for the treatment of spinal metastatic tumors resulted in a significant short-term reduction of pain, with minimal total complications. The LTP rate was additionally low. The clinical efficacy and safety of this technique are established, although further exploration of the long-term outcomes of RFA+VCA is warranted.
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Affiliation(s)
- Andrew L. Chen
- Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX, United States
| | - Navraj S. Sagoo
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Christopher Vannabouathong
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Yashas Reddy
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 19107, United States
| | - Sathvik Deme
- Texas Tech University Health Sciences Center School of Medicine, 3601 4th St, Lubbock, TX, United States
| | - Sahiti Patibandla
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Peter G. Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY 10010, United States
| | - Shaleen Vira
- Department of Orthopedic Surgery, University of Arizona College of Medicine – Phoenix, 475 N 5th St, Phoenix, AZ 85004, United States
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Wu W, Zhang X, Li X, Yu S. Can the Unipedicular Approach Replace Bipedicular Percutaneous Balloon Kyphoplasty for the Management of Metastatic Vertebral Lesions? Acad Radiol 2023; 30:2147-2155. [PMID: 36463087 DOI: 10.1016/j.acra.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 12/02/2022]
Abstract
RATIONALE AND OBJECTIVES To compare the clinical and radiographic results of bipedicular and unipedicular approaches(UPK and BPK) in the management of metastatic vertebral lesions MATERIALS AND METHODS: Eighty-two patients with 159 metastatic vertebral lesions who underwent UPK(25 cases, 69 lesions) or BPK(57 cases, 90 lesions) were retrospectively evaluated. Clinical results were assessed mainly depending on the Visual Analogue Scale(VAS) score, Oswestry Disability Index(ODI) and Quality of Life(QoL). Radiographic outcomes were evaluated primarily on the basis of bone cement distribution and changes in vertebral body height(VBH). Major and minor complications were systematically evaluated and compared to assess the safety of the 2 procedures. RESULTS No statistically significant differences were observed in age, sex, types of lesions, location of lesions, posterior vertebral body and/or pedicle involvement, percentage of vertebra invasion between the groups(p=0.17-0.83). The radiographic parameter VBH was similarly improved in both groups(p=0.26-0.93). There was a significant improvement in the clinical parameters VAS score, ODI, and QoL at each follow-up examination compared with the preoperative results(p<0.001). Significant improvement was observed in the VBH at each follow-up point(p<0.05) compared to pre-procedure. UPK was superior to BPK in terms of the operative duration(p<0.001), cement volume(p=0.004), and surgical complications(p=0.04). CONCLUSION Both UPK and BPK resulted in similar clinical and radiographic outcomes in patients with metastatic vertebral lesions. The UPK had advantages including a shorter operation and lower cement volume than the BPK, which may have played an important role in reducing the incidence of complications. UPK can replace BPK in the treatment of metastatic vertebral lesions.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Yao Y, Zhu X, Zhang N, Wang P, Liu Z, Chen Y, Xu C, Ouyang T, Meng W. Microwave ablation versus radiofrequency ablation for treating spinal metastases. Medicine (Baltimore) 2023; 102:e34092. [PMID: 37352076 PMCID: PMC10289525 DOI: 10.1097/md.0000000000034092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical efficacy and safety of microwave ablation (MWA) and radiofrequency ablation (RFA) for the treatment of spinal metastases. METHODS A literature search was performed using the PubMed, Web of Science, and Cochrane Library databases according to the PRISMA statement (as of September 20, 2022). Two independent investigators screened articles based on the inclusion and exclusion criteria and included studies with primary outcomes of pain relief, tumor control, and complications. Article quality was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool. RESULTS Sixteen articles were finally included in this study, including 630 patients with spinal metastases, with ages ranging from 51.4 to 71.3 years. Of these, 393 (62.4%) underwent MWA and 237 (37.6%) underwent RFA. After MWA and RFA treatment, visual analog scale scores significantly decreased, and the local tumor control rates were all above 80%. Complications were reported in 27.4% of patients treated with MWA compared with 10.9% of patients treated with RFA. CONCLUSION The results of this systematic review suggest that MWA alone or in combination with surgery and RFA in combination with other modalities may improve pain caused by primary tumor metastasis to the spine, and MWA alone or in combination with surgery may have better local tumor control. However, MWA appears to result in more major complications than RFA in combination with other treatment modalities.
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Affiliation(s)
- Yuming Yao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Xiang Zhu
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
| | - Na Zhang
- Department of Neurology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ping Wang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhizheng Liu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yun Chen
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cong Xu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Taohui Ouyang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Meng
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China
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Fan J, Zhang X, Li P, Wu L, Yuan Q, Bai Y, Yang S, Qiu Y, Zhang K. Microwave ablation combined with vertebral augmentation under real-time temperature monitoring for the treatment of painful spinal osteogenic metastases. BMC Neurol 2023; 23:219. [PMID: 37291501 DOI: 10.1186/s12883-023-03263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of computed tomography (CT)-guided microwave ablation combined with vertebral augmentation under real-time temperature monitoring in the treatment of painful osteogenic spinal metastases. METHODS This retrospective study included 38 patients with 63 osteogenic metastatic spinal lesions treated using CT-guided microwave ablation and vertebral augmentation under real-time temperature monitoring. Visual analog scale scores, daily morphine consumption, and Oswestry Disability Index scores were used to evaluate efficacy of the treatment. RESULTS Microwave ablation combined with vertebral augmentation reduced the mean visual analog scale scores from 6.40 ± 1.90 preoperatively to 3.32 ± 0.96 at 24 h, 2.24 ± 0.91 at 1 week, 1.92 ± 1.32 at 4 weeks, 1.79 ± 1.45 at 12 weeks, and 1.39 ± 1.12 at 24 weeks postoperatively (all p < 0.001). The mean preoperative daily morphine consumption was 108.95 ± 56.41 mg, which decreased to 50.13 ± 25.46 mg at 24 h, 31.18 ± 18.58 mg at 1 week, 22.50 ± 16.63 mg at 4 weeks, 21.71 ± 17.68 mg at 12 weeks, and 17.27 ± 16.82 mg at 24 weeks postoperatively (all p < 0.001). During the follow-up period, the Oswestry Disability Index scores significantly reduced (p < 0.001). Bone cement leakage occurred in 25 vertebral bodies, with an incidence of 39.7% (25/63). CONCLUSIONS The results indicate that microwave ablation combined with vertebral augmentation under real-time temperature monitoring is a feasible, effective, and safe treatment for painful osteoblast spinal metastases.
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Affiliation(s)
- Jing Fan
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Xusheng Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Peishun Li
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Qianqian Yuan
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Yunling Bai
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Sen Yang
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Yuanyuan Qiu
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Affiliated to Jining Medical College, Tengzhou, China.
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Colonna S, Bianconi A, Cofano F, Prior A, Di Perna G, Palmieri G, Zona G, Garbossa D, Fiaschi P. Radiofrequency Ablation in Vertebral Body Metastasis with and without Percutaneous Cement Augmentation: A Systematic Review Addressing the Need for SPINE Stability Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061164. [PMID: 36980472 PMCID: PMC10046948 DOI: 10.3390/diagnostics13061164] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/25/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge for both oncologists and surgeons. A possible alternative treatment for VBM is radiofrequency ablation (RFA), a percutaneous technique in which an alternating current is delivered to the tumor lesion producing local heating and consequent necrosis. However, RFA alone could alter the biomechanics and microanatomy of the vertebral body, thus increasing the risk of post-procedure vertebral fractures and spine instability, and indeed the aim of the present study is to investigate the effects of RFA on spine stability. A systematic review according to PRISMA-P guidelines was performed, and 17 papers were selected for the systematic review. The results show how RFA is an effective, safe, and feasible alternative to conventional radiotherapy for the treatment of VBM without indication for surgery, but spine stability is a major issue in this context. Although exerting undeniable benefits on pain control and local tumor recurrence, RFA alone increases the risk of spine instability and consequent vertebral body fractures and collapses. Concomitant safe and feasible therapeutic strategies such as percutaneous vertebroplasty and kyphoplasty have shown synergic positive effects on back pain and improvement in spine stability.
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Affiliation(s)
- Stefano Colonna
- Section of Neurosurgery, Department of Neuroscience, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126 Turin, Italy
| | - Andrea Bianconi
- Section of Neurosurgery, Department of Neuroscience, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126 Turin, Italy
| | - Fabio Cofano
- Section of Neurosurgery, Department of Neuroscience, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126 Turin, Italy
- Unità di Chirurgia Vertebrale, Humanitas Gradenigo Hospital, 10100 Turin, Italy
| | - Alessandro Prior
- Section of Neurosurgery, Department of Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, IRCCS Policlinico San Martino, University of Geneva, Largo Rosanna Benzi, 10, 16132 Genova, Italy
| | - Giuseppe Di Perna
- Unità di Chirurgia Vertebrale, Casa di Cura Città di Bra, 12042 Cuneo, Italy
| | - Giuseppe Palmieri
- Section of Neurosurgery, Department of Neuroscience, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126 Turin, Italy
| | - Gianluigi Zona
- Section of Neurosurgery, Department of Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, IRCCS Policlinico San Martino, University of Geneva, Largo Rosanna Benzi, 10, 16132 Genova, Italy
| | - Diego Garbossa
- Section of Neurosurgery, Department of Neuroscience, AOU Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126 Turin, Italy
| | - Pietro Fiaschi
- Section of Neurosurgery, Department of Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, IRCCS Policlinico San Martino, University of Geneva, Largo Rosanna Benzi, 10, 16132 Genova, Italy
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Liu Y, Yuan H, Milan S, Zhang C, Han X, Jiao D. PVP with or without microwave ablation for the treatment of painful spinal metastases from NSCLC: a retrospective case-control study. Int J Hyperthermia 2023; 40:2241687. [PMID: 37536672 DOI: 10.1080/02656736.2023.2241687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To compare the clinical efficacy of percutaneous vertebroplasty (PVP) alone and microwave ablation (MWA) combined with PVP for the treatment of painful spinal metastases from non-small cell lung cancer (NSCLC). METHODS From October 2014 to October 2021, the data of 58 NSCLC patients with refractory painful spinal metastases (visual analog scale score ≥ 5) were retrospectively collected and analyzed. Patients in Group A (n = 30) and Group B (n = 28) received PVP alone and MWA combined with PVP, respectively. The primary endpoint was pain relief. The secondary endpoints were quality of life (QoL), local tumor progression (LTP), and complications. RESULTS The technical success rate was 100% in both groups. Patients in both groups showed similar pain relief at 1-12 weeks, but patients in Group B still showed sustained pain relief at 24 weeks compared to those in Group A (p = 0.03). The assessment of QoL showed similar changes. LTP (33.00% vs. 7.14%, p = 0.02) and cement leakage rates (40.00% vs. 7.14%, p = 0.03) were lower in Group B. The multivariate analysis demonstrated spinal metastases with a maximum diameter ≤ 3.0 cm (p = 0.027) and MWA combined with PVP (p = 0.028) were two independent protective factors for LTP. For cement leakage, spinal metastases with vertebral body compression (p = 0.019) was an independent risk factor, while MWA combined with PVP (p = 0.042) was an independent protective factor. CONCLUSION MWA combined with PVP for painful spinal metastases from NSCLC performed more sustained pain relief (>6 months) and ultimately improved QoL with lower LTP and cement leakage rates, compared to PVP alone.
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Affiliation(s)
- Yiming Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoyue Yuan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sigdel Milan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengzhi Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wu W, Zhang X, Li X, Liu H, Yu S. Clinical Evaluation of Percutaneous Kyphoplasty for the Management of Osteoblastic-Related Metastatic Vertebral Lesions. Acad Radiol 2022; 29 Suppl 3:S183-S187. [PMID: 34561162 DOI: 10.1016/j.acra.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To retrospectively evaluate the clinical efficacy and safety of percutaneous kyphoplasty (PKP) for the management of osteoblastic-related metastatic vertebral lesions. MATERIALS AND METHODS A total of 31 patients with 58 osteoblastic-related metastatic vertebral lesions underwent PKP were reviewed. The clinical efficacy was assessed based on parameters including visual analogue scale, Oswestry Disability Index, vertebral body height variation and quality of life. Major and minor complications were systematically evaluated to assess the safety of the procedure. RESULTS Average follow-up period was 22.5 ± 11.1 months(range, 3 to 46 months). The procedure duration time ranged from 50 to 180 minutes (average 96.8 ± 36.9 minutes). Mean visual analogue scale scores decreased significantly from 6.1 ± 1.8 pre-operatively to 2.7 ± 1.5 at 3 days after PKP (p < 0.001), and remained largely immutable at 1 month (2.0 ± 0.7; 31 patients; p < 0.001), 3 months (2.4 ± 1.2; 30 patients; p < 0.001) and 1 year (3.0 ± 1.0; 27 patients; p < 0.001). Oswestry Disability Index scores and vertebral body height variation also changed after the procedure, with significant differences between pre-operative scores and at each follow-up examination (p < 0.001). Mean quality of life scores were 90.8 ± 12.9 pre-operatively and improved to 99.5 ± 12.1(27 patients, p < 0.001) at 1 year after PKP. The only minor encountered complication was bone cement leakage, which was seen in 6.5%(2 of 31) of patients. None of the patients experienced major complications. CONCLUSION PKP is a safe and effective treatment strategy for osteoblastic-related metastatic vertebral lesions from a variety of tumor etiologies.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Huanmei Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China.
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Tieppo Francio V, Gill B, Rupp A, Sack A, Sayed D. Interventional Procedures for Vertebral Diseases: Spinal Tumor Ablation, Vertebral Augmentation, and Basivertebral Nerve Ablation-A Scoping Review. Healthcare (Basel) 2021; 9:1554. [PMID: 34828599 PMCID: PMC8624649 DOI: 10.3390/healthcare9111554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022] Open
Abstract
Low back pain is consistently documented as the most expensive and leading cause of disability. The majority of cases have non-specific etiologies. However, a subset of vertebral diseases has well-documented pain generators, including vertebral body tumors, vertebral body fractures, and vertebral endplate injury. Over the past two decades, specific interventional procedures targeting these anatomical pain generators have been widely studied, including spinal tumor ablation, vertebral augmentation, and basivertebral nerve ablation. This scoping review summarizes safety and clinical efficacy and discusses the impact on healthcare utilization of these interventions. Vertebral-related diseases remain a top concern with regard to prevalence and amount of health care spending worldwide. Our study shows that for a subset of disorders related to the vertebrae, spinal tumor ablation, vertebral augmentation, and basivertebral nerve ablation are safe and clinically effective interventions to decrease pain, improve function and quality of life, and potentially reduce mortality, improve survival, and overall offer cost-saving opportunities.
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Affiliation(s)
- Vincius Tieppo Francio
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA;
| | - Benjamin Gill
- Department of Physical Medicine and Rehabilitation, The University of Missouri, Columbia, MO 65212, USA;
| | - Adam Rupp
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA;
| | - Andrew Sack
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA; (A.S.); (D.S.)
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA; (A.S.); (D.S.)
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Orenday-Barraza JM, Cavagnaro MJ, Avila MJ, Strouse IM, Dowell A, Kisana H, Khan N, Ravinsky R, Baaj AA. 10-Year Trends in the Surgical Management of Patients with Spinal Metastases: A Scoping Review. World Neurosurg 2021; 157:170-186.e3. [PMID: 34655822 DOI: 10.1016/j.wneu.2021.10.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Spinal metastases are present in approximately 20% of patients with cancer, giving a risk for neurologic dysfunction and instability. In already frail patients, surgeons strive to improve quality of life. Our goal was to review a 10-year trend in the surgical management of spinal metastases. METHODS A scoping review was performed systematically using PubMed to assess trends in surgical treatment for spinal metastases. The search terms used were: metastas∗, "neoplasm metastasis"[Mesh], "Spine"[Mesh], spine, spinal, "vertebral column," "vertebral body," laser, robot, radiofrequency, screws, fixation, "separation surgery," corpectomy, vertebrectomy, spondylectomy, vertebroplasty, kyphoplasty, surgery, "open surgery," "mini open surgery," "minimally invasive surgery," endoscopy, thoracoscopy, corpectom∗, vertebrectom∗, spondylectom∗, "en bloc," and MIS. The variables of interest were neurologic improvement, tumor recurrence, reoperation, and overall survival. RESULTS A total of 2132 articles were found within the primary query. Fifty-six studies were selected for final review. The results were organized into main surgical practices: decompression, mechanical stabilization, and pain management. For separation surgery, clinical outcomes were overall 1-year survival, 40.7%-78.4%; recurrence rate, 4.3%-22%; reoperation, 5%; and complications, 5.4%-14%. For corpectomy, clinical outcomes were overall 1-year survival, 30%-92%; reoperation, 1.1%-50%; and recurrence rate, of 1.1%-28%. Complications and reoperations with spinal instrumentation were 0%-13.6% and 0%-15%, respectively. Cement augmentation achieved pain reduction rates of 56%-100%, neurologic improvement/stability 84%-100%, and complication rates 6%-56%. Laser achieved local tumor control rate of 71%-82% at 1 year follow-up, reoperation rate of 15%-31%, and complication rate of 5%-26%. CONCLUSIONS Minimally invasive techniques for decompression and stabilization seem to be the preferred method to surgically treat metastatic spine disease, with good outcomes. More research with high level of evidence is required to support the long-term outcomes of these approaches.
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Affiliation(s)
| | - María José Cavagnaro
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Mauricio J Avila
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Isabel M Strouse
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Aaron Dowell
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Haroon Kisana
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Naushaba Khan
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Robert Ravinsky
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Ali A Baaj
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
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11
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Wu W, Zhang X, Li X, Liu H, Xu L, Liu T, Yu S. Comparison of the clinical outcomes of percutaneous kyphoplasty for the management of osteolytic and osteoblastic-related metastatic vertebral lesions. J Neurointerv Surg 2021; 14:938-941. [PMID: 34475252 DOI: 10.1136/neurintsurg-2021-018007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To retrospectively compare the clinical efficacy and safety of percutaneous kyphoplasty (PKP) for the management of osteolytic and osteoblastic-related metastatic vertebral lesions. METHODS A total of 117 patients with osteolytic (87 cases, 159 lesions, OL group) or osteoblastic-related (30 cases, 56 lesions, OB group) metastatic vertebral lesions underwent PKP. The clinical efficacy was assessed based on parameters including Visual Analog Scale (VAS), Oswestry Disability Index (ODI), vertebral body height (VBH) variation, and quality of life (QoL). Major and minor complications were systematically evaluated to assess the safety of the procedure. RESULTS No significant differences were found in the age, sex, or amount of bone cement between both groups (p>0.05). Compared with the OB group, the OL group was superior in operation duration (p<0.05) but was inferior in inflation pressure (p<0.05). Both groups experienced significant pain relief and improvement in the ODI, VBH, and QoL after PKP (p<0.05). The OB group had a better pain relief according to the VAS score but a poorer VBH restoration than the OL group throughout the follow-up period (p<0.05). No significant differences were observed in ODI and QoL between the two groups (p>0.05). The incidence of complications in the OL group was significantly higher than that in the OB group (p<0.05). CONCLUSIONS PKP can safely achieve pain relief, functional improvement, VBH restoration, and QoL improvement for patients with osteolytic or osteoblastic-related metastatic vertebral lesions. Patients with osteolytic metastatic vertebral lesions showed better VBH restoration and had a shorter operation time but experienced less pain relief and had a greater incidence of complications than patients with osteoblastic-related metastatic vertebral lesions after PKP.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanmei Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Libin Xu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Sharma R, Sagoo NS, Haider AS, Sharma N, Haider M, Sharma IK, Igbinigie M, Aya KL, Aoun SG, Vira S. Iodine-125 radioactive seed brachytherapy as a treatment for spine and bone metastases: A systematic review and meta-analysis. Surg Oncol 2021; 38:101618. [PMID: 34153905 DOI: 10.1016/j.suronc.2021.101618] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the analgesic efficacy, safety, and local tumor control of iodine-125 (125I) seed brachytherapy (BT) for the management of spine and bone metastases. METHODS A systematic literature search was conducted using PubMed, the Cochrane Library, and Scopus databases. Data regarding patient demographics, tumor characteristics, procedural parameters, and clinical outcomes were extracted and analyzed. RESULTS Fourteen studies (7 prospective, 7 retrospective) were included, accounting for 689 patients, in our review. Analgesic efficacy was assessed at baseline and various postoperative time points. Significant improvement in pain was noted at 4- and 24-week follow-ups (p < 0.01). Interestingly, all studies that combined 125I seed BT with cement augmentation reported relatively higher levels of pain reduction (mean pain reduction ≥4 points) as compared to the studies which applied 125I seed BT as a stand-alone therapy (mean pain reduction ≥2 points), at the last follow-up. Local tumor control rates ranged widely from 14% to 100% at varying follow-ups. Median overall survival ranged between 10 months and 25 months. The overall complication rate was 19% (130/689) and mainly included minor subcutaneous hemorrhage, fever, myelosuppression, and seed displacement. Metrics assessing performance and quality of life demonstrated significant improvements from baseline to posttreatment. CONCLUSION 125I seed BT, alone or in conjunction with cement augmentation, may be a viable salvage therapy in appropriately selected patients. However, further studies are needed to analyze the long-term efficacy of this intervention as a palliative and curative modality.
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Affiliation(s)
- Ruhi Sharma
- Ross University School of Medicine, Miramar, FL, USA
| | - Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Bryan, TX, USA
| | - Neha Sharma
- Roseman University of Health Sciences, South Jordan, UT, USA
| | - Maryam Haider
- McGovern Medical School at UTHealth, Houston, TX, USA
| | | | - Matthew Igbinigie
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kessiena L Aya
- Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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13
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Zhang X, Ye X, Zhang K, Qiu Y, Fan W, Yuan Q, Fan J, Wu L, Yang S, Hu M, Xing C, Chen L, Zhang L, Wang J, Song C, Wang C. Computed Tomography‒Guided Microwave Ablation Combined with Osteoplasty for the Treatment of Bone Metastases: A Multicenter Clinical Study. J Vasc Interv Radiol 2021; 32:861-868. [PMID: 33771712 DOI: 10.1016/j.jvir.2021.03.523] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of combined microwave ablation (MWA) and osteoplasty as a palliative therapy for painful bone metastases. MATERIALS AND METHODS As an extension of a previous limited single-center study, a retrospective review was conducted for 147 patients (77 male, 70 female) with painful bone metastases who underwent MWA combined with osteoplasty. In total, 102 (69.4%), 41 (27.9%), and 4 (2.7%) patients had spinal metastases, extraspinal metastases, and both, respectively. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry disability index (ODI) scores before treatment and during the follow-up period (mean follow-up, 9.8 months; range 3-16). RESULTS The mean VAS score significantly declined from 6.4 ± 2.3 before treatment to 3.2 ± 2.1, 1.9 ± 1.6, 1.8 ± 1.6, 1.8 ± 1.6, and 1.9 ± 1.6 at 24 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after treatment, respectively (P < .01). Furthermore, the mean daily morphine equivalent opioid consumption was significantly reduced from 81.5 ± 32.8 mg before treatment to 40.0 ± 20.6, 32.4 ± 10.2, 26.4 ± 10.0, 21.5 ± 8.3, and 19.3 ± 7.4 mg. The mean ODI score also declined after treatment (P < .0001). Major complications occurred in 4 of 147 patients, with 1 pathologic fracture, 1 nerve injury, and 2 mild skin infections. Minor cement leakages were observed at 69 sites (32.8%). CONCLUSIONS MWA combined with osteoplasty is an effective and safe treatment for painful bone metastases.
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Affiliation(s)
- Xusheng Zhang
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China.
| | - Yuanyuan Qiu
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Wenjuan Fan
- Department of Rheumatology and Immunology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Qianqian Yuan
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Jing Fan
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Shen Yang
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Miaomiao Hu
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Chao Xing
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Lili Chen
- Department of Oncology, Tengzhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, Shandong Province, China
| | - Liangming Zhang
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Junye Wang
- Department of Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Changming Song
- Department of Oncology, Shouguang Hospital of Traditional Chinese Medicine, Shouguang, Shandong, China
| | - Chuntang Wang
- Department of Thoracic Surgery, The Second People's Hospital of Dezhou, Dezhou, Shandong, China
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