Abstract
Vertebral metastases are frequently asymptomatic; however, the occurrence of a pathological (micro-)fracture may be associated with unremitting pain, instability, and even kyphoscoliotic deformity and require prompt and effective treatment. In symptomatic patients, the beneficial effect of conservative therapies requires too much time. Vertebroplasty (VP) may be an additional or even alternative local treatment modality for such patients. Currently, up to 80% of VP patients report important relief of metastasis-related pain. Ongoing deformity of the vertebral body is avoided. Morbidity rates are very low and the complication rates are markedly below 10%. Fatalities, if any, are almost always the result of cancer comorbidity rather than related to the VP procedure itself. The patient’s mobility is often improved, thus avoiding much of the comorbidity of prolonged conservative treatment and bed rest. VP can successfully be combined with chemotherapy, radiotherapy, neurodecompression, and instrumentation.
Even though VP is no panacea, it may be helpful to selected patients and instantly improve quality of life. Currently, VP has a solid basis for the palliative treatment of thoracic, lumbar, and sacral metastasis.
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References
Harrington, K.D. (1986). Metastatic disease of the spine. J Bone Joint Surg. Am. 68:1110–1115.
Deramond, H., Depriester, C. and Toussaint, P. (1996). Vertébroplastie et radiologie interventionnelle percutanée dans les métastases osseuses: technique, indications, contre-indications. Bull Cancer Radiother. 83:277–282.
Weill, A., et al. (1996). Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology 199:241–247.
Cotten, A., et al. (1996). Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesions filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 200:525–530.
Schaberg, J. and Gainor, B.J. (1985). A profile of metastatic carcinoma of the spine. Spine 10:19–20.
Jenis, L.G., Dunn, E.J. and An, H.S. (1999). Metastatic disease of the cervical spine. Clin. Orthop. 359:89–103.
Cotten, A., et al. (1998). Percutaneous vertebroplasty: state of the art. Radiographics 18:311–323.
Deramond, H., Depriester, C., Galibert, P. and Le Gars, D. (1998). Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol. Clin. North Am. 36:533–546.
Murphy, K.J. and Deramond, H. (2000). Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin. North Am. 10:535–545.
Kaemmerlen, P., et al. (1989). Vertébroplastie percutanée dans le traitement des métastases. Technique et résultats. J. Radiol. 70:557–562.
Cortet, B., et al. (1997). Intérêt de la vertébroplastie dans le traitement des métastases ostéolytiques et du myélome. Rev. Rhum. Ed. Fr. 64:189–195.
Chiras, J., et al. (1995). Vertébroplasties percutanées. Rev. Med. Interne 16:854–859.
Galibert, P., Deramond, H., Rosat, P. and Le Gars, D. (1987). Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée. Neurochirurgie 33:66–68.
Galibert, P. and Deramond, H. (1990). La vertébroplastie acrylique percutanée comme traitement des angiomes vertébraux et des affections dolorigènes et fragilisantes du rachis. Chirurgie 116:326–335.
Bascoulergue, Y., Duquesnel, J., Leclercq, R., Mottolese, C. and Lapras, C. (1988). Percutaneous injection of methyl methacrylate in the vertebral body for the treatment of various diseases: percutaneous vertebroplasty. Radiology 169(P):372 (abstract).
Deramond, H., Debussche, C., Pruvo, J.P. and Galibert, P. (1990). La vertébroplastie. Feuillets Radiol 30:262–268.
Levine, S.A., Perin, L.A., Hayes, D. and Hayes, W.S. (2000). An evidence-based evaluation of percutaneous vertebroplasty. Manag. Care 9:56–63.
Wenger, M. and Markwalder, T.M. (1999). Surgically controlled, transpedicular methyl methacrylate vertebroplasty with fluoroscopic guidance. Acta Neurochir. 141:625–631.
Wenger, M. and Markwalder, T.M. (2000). Percutaneous vertebroplasty for pain relief and spinal stabilization. (letter). Spine 25:2968–2969.
Wenger, M., Braun, M. and Markwalder, T.M. (2002). Vertébroplastie et kyphoplastie: une revue. Rev. Med. Suisse Romande 122:557–560.
Do, H.M. (2000). Magnetic resonance imaging in the evaluation of patients for percutaneous vertebroplasty. Topics Magn. Reson. Imaging 11:235–244.
Minart, D., Vallée, J.N., Cormier, E. and Chiras, J. (2001). Percutaneous coaxial transpedicular biopsy of vertebral body lesions during vertebroplasty. Neuroadiology 43:409–412.
Boriani, S., et al. (1996). En bloc resection of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients. Spine 21:1927–1931.
Abe, E., et al. (2001). Total spondylectomy for primary malignant, aggressive benign, and solitary metastatic bone tumors of the thoracolumbar spine. J. Spinal Disord. 3:237–246.
Chiras, J., Depriester, C., Weill, A., Sola-Martinez, M.T. and Deramond, H. (1997). Vertébroplasties percutanées. Technique et indications. J. Neuroradiol 24:45–59.
Dufresne, A.C., Brunet, E., Sola-Martinez, M.T., Rose, M. and Chiras, J. (1998). Vertébroplastie percutanée de la charnière cervico-dorsale par voie antérieure. Technique et résultats. A propos de neuf cas. J. Neuroradiol. 25:123–128.
Tong, F.C., Cloft, H.J., Joseph, G.J., Rodts, G.R. and Dion, J.E. (2000). Transoral approach to cervical vertebroplasty for multiple myeloma. Am. J. Roentgenol. 175:1322–1324.
Wetzel, S.G., Martin, J.B., Somon, T., Wilhelm, K. and Rüfenacht, D.A. (2002). Painful osteolytic metastasis of the atlas: treatment with percutaneous vertebroplasty. Spine 27:E493-E495.
Martin, J.B., et al. (1999). Vertebroplasty: clinical experience and follow-up results. Bone 25:11S-15S.
Murray, J.A., Bruels, M.C. and Lindberg, R.D. (1974). Irradiation of polymethylmethacrylate. In vitro gamma radiation effect. J. Bone Joint Surg. Am. 56:311–312.
Gangi, A., et al. (1998). CT-guided interventional procedures for pain management in the lumbosacral spine. Radiographics 18:621–633.
Hierholzer, J., et al. (2002). Perkutane Vertebroplastie. Fortschr. Röntgenstr. 174:328–334.
Fourney, D.R., et al. (2003). Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J. Neurosurg. (Spine 1) 98:21–30.
Liebschner, M.A., Rosenberg, W.S. and Keaveny, T.M. (2001). Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26:1547–1554.
Batson, O.V. (1940). The function of vertebral veins and their role in the spread of metastases. Arch. Surg. 112:138–149.
Chiras, J. and Deramond, H. (1995). Complications des vertébroplasties, in Echecs et complications de la chirurgie du rachis. Chirurgie de reprise. (Saillant, G. and Laville, C., eds.), pp149–153. Sauramps médical, Paris.
Harrington, K.D. (2001). Major neurologic complications following percutaneous vertebroplasty with PMMA: a case report. J. Bone Joint Surg. Am. 83:1070–1073.
Lee, B.J., Lee, S.R. and Yoo, T.Y. (2002). Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate. A case report. Spine 27:E419-E422.
Ratliff, J., Nguyen, T. and Heiss, J. (2001). Root and spinal cord compression from methylmethacrylate vertebroplasty. Spine 26:E300-E302.
San Millán Ruíz, D., et al. (1999). Pathology findings with acrylic implants. Bone 25:85S-90S.
Deramond, H., Wright, N.T. and Belkoff, S.M. (1999). Temperature elevation caused by bone cement polymerization during vertebroplasty. Bone 25:17S-21S.
Padovani, B., Kasriel, O., Brunner, P. and Peretti-Viton, P. (1999). Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. Am. J. Neuroradiol. 20:375–377.
Jang, J.S., Lee, S.H. and Jung, S.K. (2002). Pulmonary embolisma of polymethylmethacrylate after percutaneous vertebroplasty. A report of three cases. Spine 27:E416-E418.
Bernhard, J., Heini, P.F. and Villiger, P.M. (2003). Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty. Ann. Rheum. Dis. 62:85–86.
Chen, H.L. (2002). A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth. Analg. 95:1060–1062.
Tozzi, P., et al. (2002). Management of pulmonary embolism during acrylic vertebroplasty. Ann. Thorac. Surg. 74:1706–1708.
Cunin, G., Boissonnet, H., Petite, H., Blanchat, C. and Guillemin, G. (2000). Experimental vertebroplasty using osteoconductive granular material. Spine 25:1070–1076.
Heini, P.F. and Berlemann, U. (2001). Bone substitutes in vertebroplasty. Eur. Spine J. 10:S205-S213.
Ludwig, S.C. and Boden, S.D. (2000). Osteoinductive bone graft substitutes for spinal fusion. A basic science summary. Orthop. Clin. North Am. 30:635–645.
Wang, H.M., et al. (1995). Methotrexate loaded acrylic cement in the management of skeletal metastases. Biomechanical, biological, and systemic effect. Clin. Orthop. 312:173–186.
Vasconcelos, C., Gailloud, P., Martin, J.B. and Murphy, K.J. (2001). Transient arterial hypotension induced by PMMA injection during percutaneous vertebroplasty. J. Vasc. Interv. Radiol. 12:1001–1002.
Aebli, N., et al. (2002). Fat embolism and acute hypotension during vertebroplasty. An experimental study in sheep. Spine 27:460–466.
Kaufmann, T.J., et al. (2002). Cardiovascular effects of polymethylmethacrylate use in percutaneous vertebroplasty. Am. J. Neuroradiol. 23:601–604.
Liebermann, I.C.H., et al. (2001). Initial outcomes and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638.
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Wenger, M. Vertebroplasty for metastasis. Med Oncol 20, 203–209 (2003). https://doi.org/10.1385/MO:20:3:203
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DOI: https://doi.org/10.1385/MO:20:3:203