Vertebroplasty in Metastatic Spinal Disease
Many advances have been made in the treatment of metastatic spinal disease over the last few decades. Radiotherapy offers benefit and pain relief to many patients; however, this modality provides minimal vertebral stabilization. Surgical management consists of decompression and complex fusions. Vertebroplasty offers an adjuvant therapy to both radiotherapy and surgery by providing additional stabilization and pain relief. The results of case studies suggest that including vertebroplasty in the management of these patients is beneficial. In this article the authors review the role of vertebroplasty in metastatic spinal disease.
Spinal metastases may result from nearly all malignancies, but the most frequent solid tumors spreading to the spine are breast, lung, or prostate carcinomas. Less frequently, renal, thyroid, or gastrointestinal carcinomas have been observed. The lymphoreticular malignancies, multiple myeloma and lymphoma, are also frequent causes of disseminated spinal lesions. Metastases account for 70% of all spinal tumors, and the lumbar spine is most frequently involved. Metastatic spinal lesions that cause severe back pain have a number of deleterious effects on the patient and may lead to impairment of functioning and of QOL. Furthermore, chronic pain often results in sleep loss, decreased mobility, and depression. Palliative treatment with bed rest, orthotics, NSAIDs, and narcotic medications has known complications. Radiotherapy provides significant pain relief but limited spinal stabilization. Vertebroplasty may be performed as a complement to radiotherapy to provide immediate pain relief and stabilization. In patients in whom surgery is contraindicated, vertebroplasty may be conducted to prevent further VB collapse and to improve pain relief. This article will describe the procedure and theoretical basis of vertebroplasty, the preoperative evaluation and indications for the procedure, and review studies in the literature in which this modality is used in the treatment of metastatic spinal disease.
Many advances have been made in the treatment of metastatic spinal disease over the last few decades. Radiotherapy offers benefit and pain relief to many patients; however, this modality provides minimal vertebral stabilization. Surgical management consists of decompression and complex fusions. Vertebroplasty offers an adjuvant therapy to both radiotherapy and surgery by providing additional stabilization and pain relief. The results of case studies suggest that including vertebroplasty in the management of these patients is beneficial. In this article the authors review the role of vertebroplasty in metastatic spinal disease.
Spinal metastases may result from nearly all malignancies, but the most frequent solid tumors spreading to the spine are breast, lung, or prostate carcinomas. Less frequently, renal, thyroid, or gastrointestinal carcinomas have been observed. The lymphoreticular malignancies, multiple myeloma and lymphoma, are also frequent causes of disseminated spinal lesions. Metastases account for 70% of all spinal tumors, and the lumbar spine is most frequently involved. Metastatic spinal lesions that cause severe back pain have a number of deleterious effects on the patient and may lead to impairment of functioning and of QOL. Furthermore, chronic pain often results in sleep loss, decreased mobility, and depression. Palliative treatment with bed rest, orthotics, NSAIDs, and narcotic medications has known complications. Radiotherapy provides significant pain relief but limited spinal stabilization. Vertebroplasty may be performed as a complement to radiotherapy to provide immediate pain relief and stabilization. In patients in whom surgery is contraindicated, vertebroplasty may be conducted to prevent further VB collapse and to improve pain relief. This article will describe the procedure and theoretical basis of vertebroplasty, the preoperative evaluation and indications for the procedure, and review studies in the literature in which this modality is used in the treatment of metastatic spinal disease.
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