Clinical Orthopaedics and Related Research®

, Volume 469, Issue 3, pp 715–722

Percutaneous Vertebroplasty Relieves Pain in Metastatic Cervical Fractures

  • S. Masala
  • G. C. Anselmetti
  • M. Muto
  • M. Mammucari
  • T. Volpi
  • G. Simonetti
Symposium: Current Concepts in Cervical Spine Surgery



Percutaneous vertebroplasty is currently an alternative for treating vertebral fractures of the thoracic and lumbar spine, providing both pain control and vertebral stabilization. In the cervical spine, however, percutaneous vertebroplasty is technically challenging because of the complex anatomy of this region.


We evaluated the technical feasibility, complication rate, and ability of percutaneous vertebroplasty to provide pain relief in patients with painful metastatic cervical fractures.


We retrospectively reviewed 62 patients (24 men) who, between May 2005 and May 2009, underwent vertebroplasty to treat painful metastatic cervical fractures. Each patient was evaluated by a visual analog scale for pain, number of pain analgesics, and CT and MRI before, the day after, and at 3 months after the procedure.


Two of the 62 patients had asymptomatic cement leakage in the soft tissues. We observed no delayed complications. Mean pretreatment and 24-hour posttreatment visual analog scale pain scores were 7.9 ± 1.7 and 1.5 ± 2, respectively. Immediately after surgery, the pain completely disappeared in 25 (40%) patients. Administration of analgesics was suspended in 34 (55%) patients whereas in 27 (39%) patients the median analgesics use decreased from two pills per day (range, 0–3) to 0 (range, 0–3). In two (3%) patients, analgesics administration was continued due to the persistence of pain. At 3 months, the patients reported a mean visual analog scale pain score of 1.7 ± 2.


Our data suggest, in selected patients, percutaneous vertebroplasty may be performed with a high technical success rate combined with a low complication rate, providing immediate pain relief lasting at least 3 months and a reduction in the use of analgesic drugs.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


  1. 1.
    Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976). 2000;25:923–928.Google Scholar
  2. 2.
    Barragán-Campos HM, Vallée JN, Lo D, Cormier E, Jean B, Rose M, Astagneau P, Chiras J. Percutaneous vertebroplasty for spinal metastases: complications. Radiology. 2006;238:354–362.CrossRefPubMedGoogle Scholar
  3. 3.
    Böhm P, Huber J. The surgical treatment of bony metastases of spine and limbs. J Bone Joint Surg Br. 2002;84:521–529.CrossRefPubMedGoogle Scholar
  4. 4.
    Calmels V, Vallée JN, Rose M, Chiras J. Osteoblastic and mixed spinal metastases: evaluation of the analgesic efficacy of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2007;28:570–574.PubMedGoogle Scholar
  5. 5.
    Chapman CR, Casey KL, Dubner R, Foley KM, Gracely RH, Reading AE. Pain measurement: an overview. Pain. 1985;22:1–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Chiras J, Depriester C, Weill A, Sola-Martinez MT, Deramond H. [Percutaneous vertebral surgery: technics and indications] [in French]. J Neuroradiol. 1997;24:45–59.PubMedGoogle Scholar
  7. 7.
    Cortet B, Cotten A, Boutry N, Dewatre F, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B. Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma. Rev Rhum Engl Ed. 1997;64:177–183.PubMedGoogle Scholar
  8. 8.
    Cotten A, Dewatre F, Cortet B, Assaker R, Leblond D, Duquesnoy B, Chastanet P, Clarisse J. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methylmethacrylate at clinical follow-up. Radiology. 1996;200:525–530.PubMedGoogle Scholar
  9. 9.
    Deramond H, Deprestire C, Galibert P, Le Gars D. Percutaneous vertebroplasty with polymethylmethacrylate: technique, indications and results. Radiol Clin North Am. 1998;36:533–546.CrossRefPubMedGoogle Scholar
  10. 10.
    Feydy A, Cognard C, Miaux Y, Sola Martínez MT, Weill A, Rose M, Chiras J. Acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas: report of 2 cases. Neuroradiology. 1996;38:389–391.CrossRefPubMedGoogle Scholar
  11. 11.
    Fung KY, Law SW. Management of malignant atlanto-axial tumours. J Orthop Surg (Hong Kong). 2005;13:232–239.Google Scholar
  12. 12.
    Gailloud P, Martin JB, Olivi A, Rüfenacht DA, Murphy KJ. Transoral vertebroplasty for a fractured C2 aneurysmal bone cyst. J Vasc Interv Radiol. 2002;13:340–341.CrossRefPubMedGoogle Scholar
  13. 13.
    Gerszten PC, Welch WC. Current surgical management of metastatic spinal disease. Oncology. 2000;14:1013–1024.PubMedGoogle Scholar
  14. 14.
    Gupta S, Henningsen JA, Wallace MJ, Madoff DC, Morello FA Jr, Ahrar K, Murthy R, Hicks ME. Percutaneous biopsy of head and neck lesions with CT guidance: various approaches and relevant anatomic and technical considerations. Radiographics. 2007;27:371–390.CrossRefPubMedGoogle Scholar
  15. 15.
    Hage WD, Aboulafia AJ, Aboulafia DM. Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am. 2000;31:515–528.CrossRefPubMedGoogle Scholar
  16. 16.
    Harrington K. Metastatic tumors of the spine: diagnosis and treatment. J Am Acad Orthop Surg. 1993;1:76–86.Google Scholar
  17. 17.
    Janjan N. Bone metastases: approaches and management. Semin Oncol. 2001;28:28–34.CrossRefPubMedGoogle Scholar
  18. 18.
    Jónsson B, Jónsson H Jr, Karlström G, Sjöström L. Surgery of cervical spine metastases: a retrospective study. Eur Spine J. 1994;3:76–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Levine SA, Perin LA, Hayes D, Hayes WS. An evidence-based evaluation of percutaneous vertebroplasty. Manag Care. 2000;9:56–60, 63.Google Scholar
  20. 20.
    Klimo P Jr, Schimdt MH. Surgical management of spinal metastases. Oncologist. 2004;9:188–196.CrossRefPubMedGoogle Scholar
  21. 21.
    Martin JB, Gailloud P, Dietrich PY, Luciani ME, Somon T, Sappino PA, Rüfenach DA. Direct transoral approach to C2 percutaneous vertebroplasty. Cardiovasc Intervent Radiol. 2002;25:517–519.CrossRefPubMedGoogle Scholar
  22. 22.
    Masala S, Mammucari M, Angelopoulos G, Fiori R, Massari F, Faria S, Simonetti G. Percutaneous vertebroplasty in the management of vertebral osteoporotic fractures: short-term, mid-term and long-term follow-up of 285 patients. Skeletal Radiol. 2009;38:863–869.CrossRefPubMedGoogle Scholar
  23. 23.
    Masala S, Massari F, Fiori R, Mammucari M, Bartolucci DA, Simonetti G. Future directions in percutaneous vertebroplasty. Radiol Med. 2009;114:976–983.CrossRefPubMedGoogle Scholar
  24. 24.
    Mercadante S. Malignant bone pain: pathophysiology and treatment. Pain. 1997;69:1–18.CrossRefPubMedGoogle Scholar
  25. 25.
    Perrin RG, McBroom RJ, Perrin RG. Metastatic tumors of the cervical spine. Clin Neurosurg. 1991;37:740–755.PubMedGoogle Scholar
  26. 26.
    Pilitsis JG, Rengachary SS. The role of vertebroplasty in metastatic spinal disease. Neurosurg Focus. 2001;11:1–4.CrossRefGoogle Scholar
  27. 27.
    Saarto T, Janes R, Tenhunen M, Kouri M. Palliative radiotherapy in the treatment of skeletal metastasis. Eur J Pain. 1989;6:323–330.CrossRefGoogle Scholar
  28. 28.
    Sachs DC, Inamasu J, Mendel EE, Guiot BH. Transoral vertebroplasty for renal metastasis involving the axis. Spine (Phila Pa 1976). 2006;31:E925–E928.Google Scholar
  29. 29.
    Schachar NS. An update on the nonoperative treatment of patients with metastatic bone disease. Clin Orthop Relat Res. 2001;328:75–81.CrossRefGoogle Scholar
  30. 30.
    Tong FC, Cloft HJ, Joseph GJ, Rodts GR, Dion JE. Transoral approach to cervical vertebroplasty for multiple myeloma. AJR Am J Roentgenol. 2000;175:1322–1324.PubMedGoogle Scholar
  31. 31.
    Weill A, Chiras J, Simon JM, Rose M, Sola-Martinez T, Enkaoua E. Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology. 1996;199:241–247.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • S. Masala
    • 1
  • G. C. Anselmetti
    • 2
  • M. Muto
    • 3
  • M. Mammucari
    • 1
  • T. Volpi
    • 1
  • G. Simonetti
    • 1
  1. 1.Department of Diagnostic and Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiation TherapyUniversity of Rome “Tor Vergata”RomeItaly
  2. 2.Institute for Cancer Research and TreatmentCandiolo, TurinItaly
  3. 3.Department of NeuroradiologyCardarelli HospitalNaplesItaly

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