Interventional Spine

Eric, Lis, MD
Christopher, Wladyka, MD, Non ASSR Member
George, Krol, MD, Non ASSR Member
Sasan, Karimi, MD, Non ASSR Member
Elder, James, MD, Non ASSR Member
Bilsky, Mark, MD, Non ASSR Member

Paper/Non-Mentor

Purpose

Vertebral body augmentation procedures such as kyphoplasty are often performed in cancer patients with axial load pain due to pathologic spine compression fractures. The treated vertebrae often have pre-existing destruction of the posterior cortex, epidural tumor extension and spinal canal compromise which have the potential to be worsened by kyphoplasty. This study retrospectively analyzed spinal canal patency before and after kyphoplasty in cancer patients.

Methods & Materials

The authors retrospectively reviewed 29 consecutive patients with spine metastases who received kyphoplasty at 40 vertebral levels. All patients were to have there spine metastasis treated with high focused image guided radiation therapy. The pre-kyphoplasty magnetic resonance image (MRI) was compared with the intra-procedural computed tomography (CT) scan and post-procedure CT myelogram. Outcomes assessed included radiographic appearance of the spinal canal, pain and neurologic status.

Results

Before kyphoplasty, 29/40 vertebral levels (73%) had epidural tumor or bone causing minimal to moderate spinal canal compromise, and 11/40 (27%) had no spinal canal compromise. The posterior vertebral body cortex was disrupted at 20/40 levels, 50%. Epidural tumor compression on the post-kyphoplasty myelogram was unchanged in 23/29 (79%) and slightly worse in 6/29 (21%). None of the post-procedure images showed increased posterior displacement of bone fragments, and apart from one patient who experienced a transient radiculopathy referable to their kyphoplasty level no other patient experienced new neurologic symptoms attributable to their procedure. All patients had improvement in their axial load pain.

Conclusion

Kyphoplasty is a safe and effective treatment for patients with axial load pain due to spine metastases. This procedure provides pain relief with mild risk of slightly worsened epidural mass effect. Risks of new neurologic deficits are small.

References/Financial Disclosures

No disclosures