Percutaneous Vertebroplasty in Management of Painful Spinal Metastases

Background: spinal metastases are the most common and serious tumors affecting the musculoskeletal system. Pain is the most common presentation of spinal metastases that is very difficult to be treated by conservative measures. Percutaneous vertebroplasty (PV) is a minimally invasive procedure for treating pain and restoration of spinal stability with minimal complications. Objective: The aim of this study is to evaluate the role of percutaneous vertebroplasty in management of painful vertebral compression fractures due to spinal metastases. Patients and Methods: Twenty two patients were presented with severe axial pain due to vertebral compression fractures (VCFs) from solitary spinal metastases documented by clinical and radiological finding, 8 patients (36.3%) were males and 14 patients (63.7%) were females and the age ranged from 45-78 years. Results: The lumbar spine was affected in 12 patients (54.5%) and the dorsal spine was affected only in 10 patients (45.5%). The recorded complications during injection of PV were mainly localized pain at the injection site that was recorded in 1 patient (4.5%), cement extravasation was recorded in 10 patients (45.5%), asymptomatic anterior extravasation occurred in 7 patients (31.8%), lateral extravasation occurred in 1 patient (4.5%) and posterior extravasation occurred in 2 patients (9.2%) with no cord compression. 2 patients (9.2%) complained of transient radiculopathy. Cancer breast was the most common primary tumor diagnosed in 9 patients (40.9%) all of them were females, cancer lung was diagnosed in 8 patients (36.3%) 4 patients (18.2%) of them were males and 4 patients (18.2%) were females, cancer prostate was diagnosed in 3 patients (13.6%), cancer liver was diagnosed in only one male patient (4.5%), and finally cancer thyroid was diagnosed in one female patient (4.5%). Good pain relief occurred in 16 patients from 22 patients (72.7%), nearly complete pain relief in 6 patients (27.3%) and mild to moderate pain relief in 10 patients (45.4%). 4 patients (18.2%) were persistently complaining of the same pain with no improvement according to the Visual Analogue Scale (VAS). Only 2 patients (9.1%) developed post injection transient radiculopathy. Conclusion: Percutaneous vertebroplasty is a minimally invasive procedure used for treating painful spinal metastases with rapid pain relief, less soft tissue trauma, less blood loss and therefore leads to lower morbidity and mortality when compared with open spinal surgery.