Skip to main content

Advertisement

SpringerLink
Log in

Multi-Level Vertebroplasty for 6 or More Painful Osteoporotic Vertebral Body Compression Fractures Performed in the Same Procedural Setting: A Safety and Efficacy Report in Cancer Patients

  • Clinical Investigation
  • NON-VASCULAR INTERVENTIONS
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess safety and efficacy of multi-level vertebroplasty, when treating 6 or more levels in the same procedural setting for the management of osteoporotic vertebral compression fractures (oVCF) in cancer patients.

Materials and Methods

Single institution retrospective review from 2015 to 2019 of patients treated for multi-level oVCF in a single session procedural setting by vertebroplasty of 6 or more levels. Procedure outcomes collected included procedural complications, pre- and 4 week post-procedure pain score by numeric rating scale, opioid usage, and vertebral height changes.

Results

In total, 197 vertebral levels were treated in 24 procedures (mean 8.2 ± 1.8 levels). Mean procedure duration was 167 + / − 41 min, and mean postoperative hospitalization duration was 2.1 + / − 1.9 days. Four grade I or II complications occurred according to CIRSE classification. Two patients had a symptomatic pulmonary cement embolism; although there was no statistical difference between pre- and postoperative mean blood saturation (95.9 + / − 1.7% and 94.8 + / − 2.0%, respectively, p = 0.066). Pain score significantly improved after treatment (6.5 ± 1.3 vs 3.2 + / − 1.4, p < 0.0001) with a mean decrease of 3.3 (51%). Post-procedure daily opioid use also significantly improved (mean 35.8 + / − 36.8 mg/24 h vs 18.5 + / − 27.8 mg/24 h, p = 0.0089), with a mean decrease of 17.3 mg/24 h (48%). Refracture was found in 2 of 105 levels treated (1.9%), and no difference was found in thoraco-lumbar height and angulation. Five patients experienced new painful fractures at a non-treated level.

Conclusion

Multi-level vertebroplasty for 6 or more levels is a safe and effective treatment for the management of multi-level oVCF in cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CIBML:

Cancer-induced bone mass loss

oVCF:

Vertebral compression fracture

AI:

Aromatase inhibitor

ADT:

Androgen deprivation therapy

OS:

Overall survival

CT:

Computed tomography

MRI:

Magnetic resonance imaging

STIR:

Short-TI inversion recovery

NRS:

Numeric rating scale

PMMA:

Polymethyl methacrylate

CBCT:

Cone beam CT

PE:

Pulmonary embolism

cPE:

Cement pulmonary embolism

References

  1. Stupp R, Brada M, van den Bent MJ, Tonn J-C, Pentheroudakis G, on behalf of the ESMO Guidelines Working Group. High-grade glioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncolo. 2014;25(3):93–101.

    Article  Google Scholar 

  2. Planchard D, Popat S, Kerr K, et al. Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(5):863–70.

    Article  CAS  PubMed  Google Scholar 

  3. Cardoso F, Senkus E, Costa A, et al. 4th ESO–ESMO international consensus guidelines for advanced breast cancer (ABC 4)†. Ann Oncol. 2018;29(8):1634–57.

    Article  CAS  PubMed  Google Scholar 

  4. Rock E, DeMichele A. Nutritional approaches to late toxicities of adjuvant chemotherapy in breast cancer survivors. J Nutr. 3793S;133(11):3785S–93S.

    Article  CAS  PubMed  Google Scholar 

  5. LeBlanc ES, Nielson CM, Marshall LM, et al. The effects of serum testosterone, estradiol, and sex hormone binding globulin levels on fracture risk in older men. J Clin Endocrinol Metabol. 2009;94(9):3337–46.

    Article  CAS  Google Scholar 

  6. Lassemillante A-CM, Doi SAR, Hooper JD, Prins JB, Wright ORL. Prevalence of osteoporosis in prostate cancer survivors: a meta-analysis. Endocrine. 2014;45(3):370–81.

    Article  CAS  PubMed  Google Scholar 

  7. Bliuc D. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513.

    Article  CAS  PubMed  Google Scholar 

  8. Gnant M, Pfeiler G, Steger GG, et al. Adjuvant denosumab in postmenopausal patients with hormone receptor-positive breast cancer (ABCSG-18): disease-free survival results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20(3):339–51.

    Article  CAS  PubMed  Google Scholar 

  9. Coleman R, Cameron D, Dodwell D, et al. Adjuvant zoledronic acid in patients with early breast cancer: final efficacy analysis of the AZURE (BIG 01/04) randomised open-label phase 3 trial. Lancet Oncol. 2014;15(9):997–1006.

    Article  CAS  PubMed  Google Scholar 

  10. Smith MR, Saad F, Coleman R, et al. Denosumab and bone-metastasis-free survival in men with castration-resistant prostate cancer: results of a phase 3, randomised, placebo-controlled trial. The Lancet. 2012;379(9810):39–46.

    Article  CAS  Google Scholar 

  11. Gnant M, Pfeiler G, Dubsky PC, et al. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. The Lancet. 2015;386(9992):433–43.

    Article  CAS  Google Scholar 

  12. Samelson EJ, Hannan MT. Epidemiology of osteoporosis. Curr Rheumatol Rep. 2006;8(1):76–83.

    Article  PubMed  Google Scholar 

  13. Briggs AM, Greig AM, Wark JD. The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int. 2007;18(5):575–84.

    Article  CAS  PubMed  Google Scholar 

  14. Broy SB. The vertebral fracture cascade: etiology and clinical implications. J Clin Densitom. 2016;19(1):29–34.

    Article  PubMed  Google Scholar 

  15. Firanescu CE, de Vries J, Lodder P, et al. Percutaneous vertebroplasty is no risk factor for new vertebral fractures and protects against further height loss (VERTOS IV). Cardiovasc Intervent Radiol. 2019;42(7):991–1000.

    Article  PubMed  Google Scholar 

  16. Firanescu CE, de Vries J, Lodder P, et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ. 2018;361:k1551.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Anderson PA, Froyshteter AB, Tontz WL. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28(2):372–82.

    Article  PubMed  Google Scholar 

  18. Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. A pooled analysis of vitamin d dose requirements for fracture prevention. N Engl J Med. 2012;367(1):40–9.

    Article  CAS  PubMed  Google Scholar 

  19. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  20. Dworkin RH, Turk DC, Farrar JT, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1–2):9–19.

    Article  PubMed  Google Scholar 

  21. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  PubMed  Google Scholar 

  22. Wang L, Yang H, Shi Y, Jiang W, Chen L. Pulmonary cement embolism associated with percutaneous vertebroplasty or kyphoplasty: a systematic review: pulmonary embolism with PVP or PKP. Orthop Surg. 2012;4(3):182–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Baroud G, Crookshank M, Bohner M. High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine. 2006;31(22):2562–8.

    Article  PubMed  Google Scholar 

  24. Zhang H, Xu C, Zhang T, Gao Z, Zhang T. Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? Meta-Anal Pain Phys. 2017;20(1):E13–E28.

    Article  Google Scholar 

  25. Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007;297(4):387.

    Article  CAS  PubMed  Google Scholar 

  26. Koller H, Acosta F, Hempfing A, et al. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J. 2008;17(8):1073–95.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Spross C, Aghayev E, Kocher R, Röder C, Forster T, Kuelling FA. Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry. Eur Spine J. 2014;23(6):1332–8.

    Article  PubMed  Google Scholar 

  28. Buchowski JM, Kuhns CA, Bridwell KH, Lenke LG. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J. 2008;8(4):666–77.

    Article  PubMed  Google Scholar 

  29. Nardi A, Tarantino U, Ventura L, et al. Domino effect: mechanic factors role. Clin Cases Miner Bone Metab. 2011;8(2):38–42.

    PubMed  PubMed Central  Google Scholar 

  30. Imagama S, Hasegawa Y, Matsuyama Y, et al. Influence of sagittal balance and physical ability associated with exercise on quality of life in middle-aged and elderly people. Arch Osteoporos. 2011;6:13–20.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ripamonti CI, Maniezzo M, Campa T, et al. Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan. Ann Oncol. 2009;20(1):137–45.

    Article  CAS  PubMed  Google Scholar 

  32. Dimopoulos MA, Kastritis E, Bamia C, et al. Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid. Ann Oncol. 2008;20(1):117–20.

    Article  PubMed  Google Scholar 

  33. Wang H, Sribastav SS, Ye F, et al. Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures: a meta-analysis of the literature. Pain Phys. 2015;18(3):209–22.

    Google Scholar 

  34. Vogl TJ, Pflugmacher R, Hierholzer J, et al. Cement directed kyphoplasty reduces cement leakage as compared with vertebroplasty: results of a controlled, randomized trial. Spine. 2013;38(20):1730–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None. This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France

    Benjamin Moulin, Alexandre Delpla, Lambros Tselikas, Marc Al Ahmar, Clara Prud’homme, Charles Roux, Steven Yevich, Antoine Hakime, Christophe Territehau, Guillaume Gravel, Thierry De Baere & Fréderic Deschamps

  2. Pain Management Unit, Institut Gustave Roussy, Villejuif, Paris, France

    Sophie Laurent

  3. Université Paris-Sud, Le Kremlin Bicêtre, France

    Lambros Tselikas, Thierry De Baere & Fréderic Deschamps

Authors
  1. Benjamin Moulin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandre Delpla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lambros Tselikas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc Al Ahmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Clara Prud’homme
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven Yevich
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sophie Laurent
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antoine Hakime
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Christophe Territehau
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Guillaume Gravel
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Thierry De Baere
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Fréderic Deschamps
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Moulin.

Ethics declarations

Conflict of interest

Benjamin Moulin. disclosed no relevant relationships. Alexandre Delpla. disclosed no relevant relationships. Lambros Tselikas. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed payment for lectures including service on speakers’ bureaus from GE Healthcare, BTG, Cook medical, and Guerbet. Other relationships: disclosed no relevant relationships. Alexandre Delpla. disclosed no relevant relationships. Marc Al Ahmar disclosed no relevant relationships. Clara Prud’homme. disclosed no relevant relationships. Charles Roux. disclosed no relevant relationships. Steven Yevich. Disclosed no relevant relationships Salma Moalla. disclosed no relevant relationships Sophie Laurent. disclosed no relevant relationships. A.H. disclosed no relevant relationships. Christophe Teriitehau disclosed no relevant relationships. G.G. disclosed no relevant relationships. T.D.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed payment for lectures including service on speakers bureaus from GE Healthcare, Guerbet, BTG, Terumo. Other relationships: disclosed no relevant relationships. F.D. disclosed no relevant relationships.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moulin, B., Delpla, A., Tselikas, L. et al. Multi-Level Vertebroplasty for 6 or More Painful Osteoporotic Vertebral Body Compression Fractures Performed in the Same Procedural Setting: A Safety and Efficacy Report in Cancer Patients. Cardiovasc Intervent Radiol 43, 1041–1048 (2020). https://doi.org/10.1007/s00270-020-02480-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-020-02480-y

Keywords

Search

Navigation