1
|
Chao B, Jiao J, Yang L, Wang Y, Yu T, Liu H, Zhang H, Li M, Wang W, Cui X, Du S, Wang Z, Wu M. Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment. J Mater Chem B 2023; 11:9369-9385. [PMID: 37712890 DOI: 10.1039/d3tb01494k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Bone tumors are invasive diseases with a tendency toward recurrence, disability, and high mortality rates due to their grievous complications. As a commercial polymeric biomaterial, polymethylmethacrylate (PMMA) cement possesses remarkable mechanical properties, injectability, and plasticity and is, therefore, frequently applied in bone tissue engineering. Numerous positive effects in bone tumor treatment have been demonstrated, including biomechanical stabilization, analgesic effects, and tumor recurrence prevention. However, to our knowledge, a comprehensive evaluation of the application of the PMMA cement in bone tumor treatment has not yet been reported. This review comprehensively evaluates the efficiency and complications of the PMMA cement in bone tumor treatment, for the first time, and introduces advanced modification strategies, providing an objective and reliable reference for the application of the PMMA cement in treating bone tumors. We have also summarized the current research on modifications to enhance the anti-tumor efficacy of the PMMA cement, such as drug carriers and magnetic hyperthermia.
Collapse
Affiliation(s)
- Bo Chao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Jianhang Jiao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Lili Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Yang Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Tong Yu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Han Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Mufeng Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Wenjie Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Xiangran Cui
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Shangyu Du
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Minfei Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| |
Collapse
|
2
|
Deng L, Lv N, Hu X, Guan Y, Hua X, Pan Z, Zhou Q, Wang C, Li B, Qian Z. Comparison of Efficacy of Percutaneous Vertebroplasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Asymmetric Compression Fracture. World Neurosurg 2022; 167:e1225-e1230. [PMID: 36089275 DOI: 10.1016/j.wneu.2022.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND This study aims to compare the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral asymmetric compression fracture (OVACF). METHODS This study retrospectively reviewed the patients who were diagnosed with OVACF between September 2015 and July 2019. Forty-one patients received PVP surgery (group A), and 44 patients received PKP surgery (group B). The visual analog scale, Oswestry Disability Index, scoliosis angle (SA), height of long side, height of short side (HS), and lateral height difference (LHD) before operation and 3 days and 1 year after operation were compared between both groups. The operation time, fluoroscopic time, hospital stay, cement volume, and complications were also compared between both groups. RESULTS The visual analog scale and Oswestry Disability Index differed significantly between the groups 1 year after operation (P < 0.05). Compared with the preoperative results, there were significant differences in SA, height of long side, HS, and LHD 3 days and 1 year after operation (P < 0.05). Compared with group A, group B showed significantly better in SA, HS, and LHD in group B 3 days and 1 year after operation (P < 0.05). More patients in group A suffered cement leakage and scoliosis than group B after operation (P < 0.05). CONCLUSIONS In our study, PVP and PKP are both effective in the treatment of OVACF, but PKP surgery had better long-term clinical efficacy.
Collapse
Affiliation(s)
- Lei Deng
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Nanning Lv
- Department of Orthopedic Surgery, the Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Xiayu Hu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Yuehong Guan
- Department of Orthopedic Surgery, Changsu No. 2 People's Hospital, Suzhou, Jiangsu, China
| | - Xi Hua
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Zejun Pan
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Quan Zhou
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Chengyue Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Baoxin Li
- Department of Orthopedic Surgery, Affiliated Hospital of Qinghai University, Qinghai University, Xining, Qinghai, China
| | - Zhonglai Qian
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
| |
Collapse
|
3
|
Fan W, Zhou T, Li J, Sun Y, Gu Y. Freehand Minimally Invasive Pedicle Screw Fixation and Minimally Invasive Decompression for a Thoracic or Lumbar Vertebral Metastatic Tumor From Hepatocellular Carcinoma. Front Surg 2021; 8:723943. [PMID: 34926563 PMCID: PMC8671451 DOI: 10.3389/fsurg.2021.723943] [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: 07/10/2021] [Accepted: 11/05/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: To compare freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with percutaneous vertebroplasty (PVP), minimally invasive decompression, and partial tumor resection with open surgery for treatment of thoracic or lumbar vertebral metastasis of hepatocellular carcinoma (HCC) with symptoms of neurologic compression, and evaluate its feasibility, efficacy, and safety. Methods: Forty-seven patients with 1-level HCC metastatic thoracolumbar tumor and neurologic symptoms were included between February 2015 and April 2017. Among them, 21 patients underwent freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection (group 1), while 26 patients were treated with open surgery (group 2). Duration of operation, blood loss, times of fluoroscopy, incision length, and stay in hospital were compared between the two groups. Pre- and postoperative visual analog scale (VAS) pain score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) grade, ambulatory status, and urinary continence were also recorded. The Cobb angle and central and anterior vertebral body height were measured on lateral radiographs before surgery and during follow-ups. Results: Patients in group 1 showed significantly less blood loss (195.5 ± 169.1 ml vs. 873.1 ± 317.9 ml, P = 0.000), shorter incision length (3.4 ± 0.3 vs. 13.6 ± 1.8 cm, P = 0.000), shorter median stay in hospital (4–8/6 vs. 8–17/12 days, P = 0.000), more median times of fluoroscopy (5–11/6 vs. 4–7/5 times, P = 0.000), and longer duration of operation (204.8 ± 12.1 vs. 171.0 ± 12.0 min, P = 0.000) than group 2. Though VAS significantly decreased after surgery in both groups, VAS of group 1 was significantly lower than that of group 2 immediately after surgery and during follow-ups (P < 0.05). Similar results were found in ODI. No differences in the neurological improvement and spinal stability were observed between the two groups. Conclusion: Freehand MIPS combined with PVP, minimally invasive decompression, and partial tumor resection is a safe, effective, and minimally invasive method for treating thoracolumbar metastatic tumors of HCC, with less blood loss, better pain relief, and shorter length of midline incision and stay in hospital.
Collapse
Affiliation(s)
- Wenshuai Fan
- Department of Orthopedic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyao Zhou
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinghuan Li
- Department of Hepatic Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunfan Sun
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China
| | - Yutong Gu
- Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Orthopedic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| |
Collapse
|
4
|
An Overview of Decision Making in the Management of Metastatic Spinal Tumors. Indian J Orthop 2021; 55:799-814. [PMID: 34194637 PMCID: PMC8192670 DOI: 10.1007/s43465-021-00368-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/29/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Spinal metastases are the most commonly encountered spinal tumors. With increasing life expectancy and better systemic treatment options, the incidence of patients seeking treatment for spinal metastasis is rising. Radical resections and conventional low-dose radiotherapy have given way to modern 'separation' surgeries and stereotactic body radiotherapy which entails lesser morbidity and improved local control. This article provides an overview of the decision making and currently available treatment options for metastatic spinal tumors. METHODS A MEDLINE literature search was made for studies in English language reporting on human subjects, describing results of various treatment options that are a part of multidisciplinary management of metastatic spinal tumors. The highest-quality evidence available in the literature was reviewed. DISCUSSION Treatment of patients with metastatic spinal tumors is largely palliative, with radiotherapy and selective surgery being the mainstays of management. Multidisciplinary management that incorporates factors like patient performance status, expected survival and systemic burden of disease and employs well-validated decision-making frameworks for guiding treatment holds the key to an effective palliative treatment strategy. Effective pain management, achieving local control, adequate neurological decompression in the setting of epidural cord compression and surgical stabilization for mechanical stabilization are the main goals of treatment. CONCLUSION The management of metastatic spinal tumors has been rapidly evolving; currently, limited decompression and stabilization followed by postoperative SBRT for local tumor control are associated with less morbidity and may be referred to as the current standard of care in these patients.
Collapse
|
5
|
Cui Y, Pan Y, Lei M, Mi C, Wang B, Shi X. The First Algorithm Calculating Cement Injection Volumes in Patients with Spine Metastases Treated with Percutaneous Vertebroplasty. Ther Clin Risk Manag 2020; 16:417-428. [PMID: 32523346 PMCID: PMC7234973 DOI: 10.2147/tcrm.s253046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This study aims to develop an algorithm to predict cement injection volumes in patients with spine metastases treated with percutaneous vertebroplasty (PVP). Risk factors were also analyzed for intra-spinal canal cement leakages. PATIENTS AND METHODS A retrospective analysis of 584 vertebrae in 251 patients. Patients and vertebrae were divided into three groups based on grades of tumor invasion to the spinal cord. Patients with the complete posterior wall of vertebrae were classified into group A, patients without the complete posterior wall of vertebrae but with normal Dural sac were classified into group B, and patients with deformation of the Dural sac but without neurological symptom were classified into group C. We systematically reviewed demographic data, clinical parameters, radiology features, and cement leakages among the three groups. The multiple linear regressions were used to screen potential risk factors and develop the algorithm to predict injected cement volumes in vertebrae. Significant factors were included in the algorithm. Potential risk factors for intra-spinal canal cement leakage were analyzed using the multiple logistic regressions. RESULTS In the study, 17.1% (100/584) of vertebrae occurred cement leakages. Vertebrae in group C (28.6%, 8/28) had the highest cement leakage rate than patients in group A (14.4%, 61/424) and B (23.5%, 31/132) (P=0.014). Vertebrae in group C (14.3%, 4/28) were also more prone to intra-spinal canal leakages (P=0.003). The multiple logistic analysis showed that the Bilsky scale was significantly associated with intra-spinal canal cement leakages (P<0.001). The multiple linear regression analysis showed that intercept (P<0.001), treated vertebrae level (P<0.001), cortical osteolytic destruction in posterior wall (P<0.001), and Bilsky scale (P=0.014) were significant and those variables were included in the algorithm. The algorithm was Y=3.1627-0.8677×treated vertebrae level-0.6182×cortical osteolytic destruction in the posterior wall-0.2819×Bilsky scale. CONCLUSION An algorithm is proposed and can be used to calculate cement injection volumes in spine metastases treated with PVP. This algorithm can facilitate surgical planning and guide cement injections. Bilsky scale is an independent risk factor for intra-spinal canal cement leakages. We do not recommend PVP treated in patients with a Bilsky scale of 2 and 3 mainly due to a high rate of intra-spinal canal cement leakages.
Collapse
Affiliation(s)
- Yunpeng Cui
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yuanxing Pan
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, People’s Republic of China
| | - Chuan Mi
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Bing Wang
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| | - Xuedong Shi
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, People’s Republic of China
| |
Collapse
|
6
|
Amoretti N, Diego P, Amélie P, Andreani O, Foti P, Schmid-Antomarchi H, Scimeca JC, Boileau P. Percutaneous vertebroplasty in tumoral spinal fractures with posterior vertebral wall involvement: Feasibility and safety. Eur J Radiol 2018; 104:38-42. [PMID: 29857864 DOI: 10.1016/j.ejrad.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/07/2018] [Accepted: 04/06/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE to evaluate the technical feasibility and safety of CT and fluoroscopy guided percutaneous vertebroplasty in the treatment of tumoral vertebral fractures with posterior wall involvement. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this study. Sixty-three consecutive adult patients (35 women, 28 men; mean age+/- standard deviation: 69 years+/- 14) with tumoral spinal fractures that compromised the posterior wall were treated by means of percutaneous vertebroplasty with CT and fluoroscopy guidance. Only local anesthesia was used during these procedures. Postoperative outcome was assessed using the Kostuik index. RESULTS Sixty-three vertebroplasties were performed on thirty-four thoracic (54%), twenty-six lumbar (41%), and three (5%) cervical vertebrae. The etiologies of the fractures were metastasis in twenty-eight (44%), myeloma in twenty-five (40%) and hemangioma in ten (16%). Almost all fractures (94%) were consolidated after vertebroplasty (score of Kostuik <3) (p < 0.001). No major complications were reported in our series of cases. CONCLUSION This study suggests that tumoral spinal fractures with posterior vertebral wall involvement can be successfully and safely treated by CT- and fluoroscopy-guided percutaneous vertebroplasty.
Collapse
Affiliation(s)
- Nicolas Amoretti
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France.
| | - Palominos Diego
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Pellegrin Amélie
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Olivier Andreani
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Pauline Foti
- Diagnostic and Interventional Radiology Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| | - Heidy Schmid-Antomarchi
- Institut de Biologie Valrose, Université cote d'azur, Tour Pasteur, UFR Médecine, 28 Ave de Valombrose, 06107 Nice Cedex 2, France
| | - Jean-Claude Scimeca
- Institut de Biologie Valrose, Université cote d'azur, Tour Pasteur, UFR Médecine, 28 Ave de Valombrose, 06107 Nice Cedex 2, France
| | - Pascal Boileau
- Orthopaedic Surgery Unit, Nice University Hospital, 30 Voie Romaine, 06000 Nice, France
| |
Collapse
|
7
|
Mansoorinasab M, Abdolhoseinpour H. A review and update of vertebral fractures due to metastatic tumors of various sites to the spine: Percutaneous vertebroplasty. Interv Med Appl Sci 2018; 10:1-6. [PMID: 30363329 PMCID: PMC6167632 DOI: 10.1556/1646.10.2018.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Vertebral fractures (VFs) are the most usual convolution of metastatic tumors and the vertebral column is the third most ordinary site for painful bone metastases and remains a chief factor of morbidity in cancer patients. Methods In this paper, we investigated the previous literature on the status of clinical and prospects for the use of percutaneous vertebroplasty (PVP) with polymethylmethacrylate as a remedial alternative for the therapy of refractory pain resulting from malignant vertebral compression and pathologic fractures associated with metastatic tumors of various sites in numerous studies. The scientific document for this remedy, containing safety, immediate and long-term efficacy, and outcome measures, and also the risks of complications, was analyzed in detail. Results PVP is a safe, feasible, reliable, effective, and useful procedure, a minimally invasive treatment, and a significant tool for reduction of pain and the relief of pain symptoms. Conclusions This method can be employed as a further or narcotic remedy in elected patients. The techniques of PVP present a novel alternative therapy for diverse metastases with potentially large application.
Collapse
Affiliation(s)
| | - Hesam Abdolhoseinpour
- Department of Neurosurgery, Bou Ali Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
8
|
Clinical Experience Using a Remote Control Injection System in Vertebroplasty: Feasibility, Safety, and Cement Leakage of Osteoporotic and Malignant Compression Fractures. Clin Spine Surg 2017; 30:E305-E309. [PMID: 28323716 DOI: 10.1097/bsd.0000000000000028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. SUMMARY OF BACKGROUND DATA Cement leakage is a frequent occurrence in vertebroplasty and is also the main source of complications. Continuous radiographic evaluation is mandatory to detect cement leakage during injecting cement into the vertebral body, while the operator is subjected to x-ray radiation exposure. OBJECTIVE The aim of this study was to evaluate the feasibility and safety of vertebroplasty performed on patients and operators for the treatment of osteoporotic and malignant vertebral compression fractures using a remote control injection system. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective study. Clinical charts and postoperative radiographs were obtained for 74 patients (114 levels) who underwent vertebroplasty. The study group included 46 cases (71 levels) of benign osteoporotic fractures and 28 cases (43 levels) of different malignant metastatic lesions. Under fluoroscopic guidance, cement was injected using a remote control injection system, while the operator was standing outside the radiation field. The location and degree of leakage at each treated level were recorded. RESULTS Cement leakage rate reached 47.4% across all treated levels. No severe leakage in any location was observed. A total of 35 leakages were detected in 71 levels and 24 leakages were detected in 43 levels in the benign and malignant fracture group, respectively. The overall rate of cement leakages and the location of the leakages were not statistically different between the benign and malignant fracture group (P=0.60, P=0.45). With the operator standing outside the radiation field to inject cement, the radiation dose to operators was avoided during cement injection. CONCLUSIONS Vertebroplasty using a remote control injection system was feasible and safe in treatment of osteoporotic and malignant compression fractures. The cement injection system had potential benefits to decrease the leakage rate in treating malignant fractures and eliminate injection dose to operators under lateral fluoroscopic monitoring.
Collapse
|
9
|
Cui H, Zhang X, Yan R, Cheng J. Less PMMA Injection as an Independent Predictor of Poor Neurologic Recovery Following Percutaneous Vertebroplasty in Patients with Malignant Vertebral Compression Fractures. J HARD TISSUE BIOL 2017. [DOI: 10.2485/jhtb.26.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hongkai Cui
- Department of Radiology, The First Affiliated Hospital, Zhengzhou University
- Department of Interventional Radiology, The First Affiliated Hospital of Xinxiang Medical University
| | - Xianliang Zhang
- Department of Interventional Radiology, The Center Hospital of Zhoukou
| | - Ruifang Yan
- Department of Interventional Radiology, The First Affiliated Hospital of Xinxiang Medical University
| | - Jingliang Cheng
- Department of Radiology, The First Affiliated Hospital, Zhengzhou University
| |
Collapse
|
10
|
CHEN FENG, XIA YONGHUI, CAO WENZHEN, SHAN WEI, GAO YANG, FENG BO, WANG DIFEI. Percutaneous kyphoplasty for the treatment of spinal metastases. Oncol Lett 2016; 11:1799-1806. [PMID: 26998079 PMCID: PMC4774488 DOI: 10.3892/ol.2016.4121] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 11/27/2015] [Indexed: 11/06/2022] Open
Abstract
The bones are the most common location for metastases, which may cause severe pain and damage, including osteolytic destruction and fractures. Pathological fractures of the spine are extremely painful and cause significant disability and morbidity in patients. Traditional open surgery has numerous complications, and radiation therapy may take weeks to become effective. To avoid the trauma and complication of open surgery, percutaneous kyphoplasty (PKP) is a minimally invasive procedure that has played a great role in the treatment of spinal metastases over the past several years. To evaluate the efficacy and safety of the treatment of spinal metastasis using PKP, the present study evaluated 282 patients who had received PKP between April 2009 and June 2014. The efficacy of PKP was evaluated using the visual analog scale for pain (VAS), Karnofsky performance score (KPS) and quality of life (QOL) score (short form with 36 questions). The KPS and QOL were measured pre-operatively and 3 months post-operatively. In addition, radiographical data, including the degree of restoration of the kyphotic angle and the anterior vertebral height, and leakage of bone cement, were measured. The safety of the surgery was assessed by complications and side effects reported during or subsequent to surgery. The present study measured the parameters prior to the surgery and at 24 h, 3 months, 6 months and 1 year post-surgery, as well as at the last follow-up date. The range of the follow-up time was between 105 days and 15 months (mean, 401 days). The 282 patients underwent successful operations and the pain felt by the patients prior to the surgery was significantly alleviated. In addition, the analgesic intake of patients greatly decreased following PKP. KPS improved prior to and 3 months after the surgery. QOL also improved prior to and 3 months after the surgery. Radiographical data demonstrated that the kyphotic angle decreased following PKP, and the anterior vertebral height increased. Paravertebral leakage of bone cement occurred in 10 patients through a cortical defect, but without spinal cord compression or pulmonary embolism. Therefore, as a minimally invasive procedure, PKP may not only rapidly relieve the pain and disability experienced by patients, but it may also restore the kyphotic angle observed at the 1-year follow-up. Notably, PKP may safely improve the QOL of patients.
Collapse
Affiliation(s)
- FENG CHEN
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - YONG-HUI XIA
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - WEN-ZHEN CAO
- Department of Intensive Care Unit Department, Qianfoshan Hospital Affiliated to Shandong University Jinan, Shandong 250014, P.R. China
| | - WEI SHAN
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - YANG GAO
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - BO FENG
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - DIFEI WANG
- Department of Geriatrics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| |
Collapse
|
11
|
Sun G, Jin P, Li M, Lui X, Li F, Xie Z, Ding J, Peng Z. Three-dimensional C-arm computed tomography combined with fluoroscopic guided pediculoplasty for treatment of vertebral body metastasis with lytic pedicle. Technol Cancer Res Treat 2015; 11:169-74. [PMID: 22335411 DOI: 10.7785/tcrt.2012.500246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this retrospective study was to evaluate a percutaneous pediculoplasty (PP) technique, using 3-dimensional C-arm CT reformation combined with fluoroscopic guidance for patients presented vertebral body metastasis with lytic pedicle. Thirteen patients (average age 57.8 years) were treated through lytic pedicle approach in our study. Subjective good and partial pain relief was reported with Visual Analogue Scale reduction ≥ 4 in 11/13 patients at 1 month after procedure, two patients with insufficient pain relief died from clinical complications unrelated with PP at 3 month follow-up. Pain relief was maintained in 10 patients at 6 month post-procedural follow-up. One patient died from underlying disease unrelated with the procedure at 5 month follow-up. PP through the lytic pedicle approach under 3-dimensional C-arm CT reformation combined with fluoroscopic guidance was a feasible, safe, and minimally invasive procedure that could provide both the precise control of needle placement and cement injection with one imaging system.
Collapse
Affiliation(s)
- Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, 25# Shifan Road, Ji'nan, Shandong, 250031 P.R. China .
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Sun G, Li L, Jin P, Liu XW, Li M. Percutaneous vertebroplasty for painful spinal metastasis with epidural encroachment. J Surg Oncol 2014; 110:123-8. [PMID: 24665071 DOI: 10.1002/jso.23608] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/25/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Gang Sun
- Department of Medical Imaging; Jinan Military General Hospital; Jinan Shandong Province China
| | - Li Li
- Department of Medical Imaging; Jinan Military General Hospital; Jinan Shandong Province China
| | - Peng Jin
- Department of Medical Imaging; Jinan Military General Hospital; Jinan Shandong Province China
| | - Xun-wei Liu
- Department of Medical Imaging; Jinan Military General Hospital; Jinan Shandong Province China
| | - Min Li
- Department of Medical Imaging; Jinan Military General Hospital; Jinan Shandong Province China
| |
Collapse
|
13
|
Cementoplasty for managing painful bone metastases outside the spine. Eur Radiol 2013; 24:731-7. [DOI: 10.1007/s00330-013-3071-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/08/2013] [Accepted: 10/28/2013] [Indexed: 01/12/2023]
|
14
|
Comparison of percutaneous vertebroplasty with and without interventional tumour removal for malignant vertebral compression fractures with symptoms of neurological compression. Eur Radiol 2013; 23:2754-63. [PMID: 23760302 DOI: 10.1007/s00330-013-2893-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/29/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the efficacy of percutaneous vertebroplasty (PVP) with and without interventional tumor removal (ITR) on malignant vertebral compression fractures and symptoms of neurological compression. MATERIALS AND METHODS A total of 52 patients with malignant vertebral compression fractures and symptoms of neurological compression were selected for PVP and ITR (n = 24, group A) or PVP alone (n = 28, group B). A 14-G needle and a guidewire were inserted into the vertebral body, followed by sequential dilatation of the tract with the working cannula until the last working cannula reached the distal pedicle of the vertebral arch. ITR was performed with marrow nucleus rongeurs. Then, 5-10 mL cement was injected into the extirpated vertebral body. RESULTS PVP procedures with and without ITR were successful in all patients, except for one patient in group A. The clinical assessment obtained at the initial and final follow-up indicated that the rates of full recovery and improved neurological compression symptoms were significantly higher in group A than in group B (P < 0.05). CONCLUSION Treatment of malignant vertebral compression fractures with symptoms of neurological compression with PVP and ITR resulted in better intermediate-term clinical results in terms of improved neurological compression symptoms than the currently recommended approach of PVP. KEY POINTS • Percutaneous vertebroplasty (PVP) is now widely used for vertebral collapse due to malignancy • PVP can be coupled with interventional tumour removal (ITR) • PVP coupled with ITR provided better clinical results for neurological compression • PVP coupled with ITR provided better pain relief • PVP and ITR can remove tumour and helps prevent polymethyl methacrylate leakage.
Collapse
|
15
|
Liu XW, Jin P, Wang LJ, Li M, Sun G. Vertebroplasty in the treatment of symptomatic vertebral haemangiomas without neurological deficit. Eur Radiol 2013; 23:2575-81. [PMID: 23620368 DOI: 10.1007/s00330-013-2843-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/19/2013] [Accepted: 02/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of vertebroplasty in symptomatic vertebral haemangiomas (VHs) with no neurological deficit, with or without features of aggressiveness in imaging studies. METHODS A retrospective study was conducted to review 31 consecutive patients with symptomatic VHs that underwent vertebroplasty procedures (13 males, 18 females; mean age, 57.5 years), for a total of 33 affected vertebral levels (range, T4-L5 levels). Pre procedure radiological examinations were reviewed. The presence of predominant soft tissue stroma on CT, low signals on T1W of MRI, epidural tissue, and cortical erosion are considered features of aggressiveness. The clinical effects were evaluated using the visual analogue scale (VAS) and modified Roland-Morris Disability Questionnaire (RDQ) at the pre and each postoperative follow-up time point (mean follow-up of 15.8 months). RESULTS Symptomatic VHs with no signs of aggressiveness were observed in 26 lesions and those with signs of aggressiveness in 7 lesions. Vertebroplasty was successfully performed under fluoroscopic guidance with a unipedicular approach in 16 levels, a bipedicular approach in 17 levels. VAS scores and RDQ scores were significantly improved after vertebroplasty (P < 0.001). Extraosseous cement leakage was observed in 4 patients without clinical complications. CONCLUSIONS Vertebroplasty is an optional treatment for symptomatic VHs with no neurological deficit. KEY POINTS • Vertebral haemangiomas with or without aggressive signs may cause pain. • Radiological signs of aggressiveness include evidence of lesions that contain less fat predominance, evidence of epidural soft tissue and evidence of cortical erosion. • Vertebroplasty provides effective treatment for symptomatic vertebral haemangiomas causing no neurological deficit.
Collapse
Affiliation(s)
- Xun-Wei Liu
- Department of Medical Imaging, Jinan Military General Hospital, No,25, Shifan Road, Jinan, Shandong, China, 250031.
| | | | | | | | | |
Collapse
|
16
|
Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-25. [DOI: 10.1097/spc.0b013e328350f70c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Three-dimensional C-arm computed tomography reformation combined with fluoroscopic-guided sacroplasty for sacral metastases. Support Care Cancer 2011; 20:2083-8. [PMID: 22081116 DOI: 10.1007/s00520-011-1317-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 11/01/2011] [Indexed: 10/15/2022]
Abstract
The aim of this retrospective study was to evaluate a sacroplasty technique, using three-dimensional C-arm CT reformation combined with fluoroscopic guidance for patients with severe painful sacral metastases. We studied the data of seven patients (average age 55.7 years) treated through trans-sacroiliac joint approach with the technique. Patients with additional thoracolumbar osteolytic metastases (five out of seven) also received concomitant vertebroplasty accordingly. Subjective significant pain relief was reported with visual analogue scale reduction ≥4 in all seven patients at 1 month after procedure, six out of seven at 3 months, and five out of six at 6 months. Pain recurrence was reported in two patients at 3 and 6 months follow-up, respectively, associated with their clinical evidence of tumor progression. One patient died from underlying disease unrelated with the procedure. Sacroplasty under three-dimensional C-arm CT reformation combined with fluoroscopic guidance was a feasible, safe, and minimally invasive procedure that could provide both the precise control of needle placement and cement injection with one imaging system.
Collapse
|
18
|
Percutaneous cementoplasty for painful osteolytic humeral metastases: initial experience with an innovative technique. Skeletal Radiol 2011; 40:1345-8. [PMID: 21491154 DOI: 10.1007/s00256-011-1170-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 02/02/2023]
|
19
|
Height restoration and wedge angle correction effects of percutaneous vertebroplasty: association with intraosseous clefts. Eur Radiol 2011; 21:2597-603. [PMID: 21822947 DOI: 10.1007/s00330-011-2218-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 06/14/2011] [Accepted: 06/22/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate effects of vertebroplasty on restoration of vertebral body height and wedge angle and relief from pain in patients with osteoporotic compression fractures. METHODS A retrospective study of 156 patients (232 levels) who had undergone vertebroplasty was conducted. Treated vertebrae with cleft included 49 patients (49 levels) and that without cleft 107 patients (183 levels). Effects on restoration of vertebral body height and wedge angle, and pain scores between pre- and post-procedure were statistically analyzed by using a paired-sample t test, and Kruskal Wallis test. RESULTS The height and wedge angle of the fractured vertebral body, and pain score, improved significantly after vertebroplasty. On a vertebra-by-vertebra analysis, the vertebral body height and wedge angle in the cleft group, were statistically significantly better post-procedure (P < 0.01); in the non-cleft group, there was nosignificant improved (P > 0.05). Pain relief was not statistically significant different between the two groups (P > 0.05). CONCLUSION Most patients experienced pain relief after vertebroplasty. After vertebroplasty, the height and wedge angle were significantly improved in the cleft group (p < 0.01), with no significant improvement in the non-cleft group (p > 0.05). Key Points • Vertebra with cleft is attributed to improvement of the spinal deformity • Vertebra without cleft was not associated with improvement of the spinal deformity • Vertebroplasty is an effective treatment strategy for osteoporotic compression fractures.
Collapse
|