Percutaneous transpedicular vertebroplasty with polymethyl methacrylate for pathological fracture of the spine

We aimed to evaluate the safety and therapeutic efficacy of percutaneous transpedicular vertebroplasty (PVP) using polymethyl methacrylate (PMMA) in patients with symptomatic metastatic spine lesions. We included 31 patients in this retrospective study who were treated with PMMA from 2003 to 2005 for intractable pain due to metastatic spine lesions. The types of cancer (and numbers of patients) included: lung cancer (9), breast cancer (7), gastrointestinal (GI) tract cancers (5), hepatobiliary malignancies (3), and other types of cancer (7). All patients received vertebroplasty, resulting in 41 treatments (16 in thoracic, 25 in lumbar spine). Preoperative and postoperative visual analog scale (VAS) scores for pain were measured in all patients. Image studies including contrast-enhanced MRI were performed in all patients. Results showed characteristic metastatic lesions. Suspicious lesions were further confirmed as malignant by a bone scan, a positron emission tomography (PET) scan, and pathological exam. Vertebroplasty resulted in complete or partial pain relief in 29 patients (95%), and provided no pain relief in 2 patients (5%). The mean preoperative VAS score of 8.9 (+/- 0.93) was higher than the mean postoperative VAS score (2.6 +/- 1.71). Metastatic spine lesions were most common in lung and breast cancer patients and these lesions were located more often on segments T12 to L2 (53.6%). Patients with malignancy of hepatobiliary origin did not show improvement in pain scores as dramatically as patients with other types of malignancies, although only a few cases were included in this study. No patients experienced worsening of symptoms or suffered from vertebroplasty complications. We conclude that vertebroplasty is a safe, effective, and simple treatment for the management of intractable spinal pain due to metastases. Crown Copyright (C) 2009 Published by Elsevier Ltd. All rights reserved.