10 years of balloon kyphoplasty in malignant vertebral body lesions: Critical analysis of benefits and complications

Abstract

Objective(s): Affection of the spine by metastases threatens the patients with pain, loss of mobility and neurologic defects. Treatment options have to meet concerns of the short term prognosis, the limited operability and should allow quick mobilisation and short hospital stay. An answer is the minimally invasive percutaneous augmentation of the vertebra by CT-guided dilatation and injection of bone cement (methylmethacrylate). Benefits are immediate mobilization after the procedure, minimized surgical trauma and no need of an additional orthesis. Cement leakage rates are increased compared to kyphoplasty procedures of osteoporotic fractures, but no oncologic patient reqired a surgical revision. Material & Methods: The patients were documented prospectively by ASA - Score, Karnovsky - Index, Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Percutaneous kyphoplasty was guided with CTand combined with fluoroscopy. All patients were aftertreated functionally with early mobilisation. Epidural tumor involvement was no contraindication. Results: From 05/2000 to 05/2011 out of 1117 kyphoplasties 115 patients with metastatic lesions were treated. The localisation favorites the thoracolumbar junction. The subjective evaluation using the VAS showed a decrease of the pain level of 60 % in 80% of the patients. All patients were mobile without orthesis after the procedure. The clinical and radiological followups after 6 and 12 months confirmed the good results in the ODI however 24 patients had died in between. Radiologically, all survivers showed an unaltered mechanical sufficient bone cement material. The complication rate is on the lower limit of the literature, but increased compared to kyphoplasty procedures of osteoporotic fractures. Complications refer to paravasations of the bone cement (40 patients, 35 %): 8 patients showed temporary radiculopathy, 31 patients with intervertebral, vascular or paravertebral paravasation stayed asymptomatic. 9 patients showed epidural paravasation without neurological impairment, no oncologic patient required surgical revision. Conclusion(s): Percutaneous kyphoplasty is an excellent method of palliation for pain relief and mobility in oncologic patients with cancer metastases of the spine.