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Practical management of malignant compression fractures
  1. Joshua A Hirsch1,
  2. Ariel E Hirsch2,
  3. Ruchira Jha3,
  4. Marion Growney1,
  5. James D Rabinov1,
  6. Raul G Nogueira1,
  7. Johnny C Pryor1,
  8. Albert J Yoo1
  1. 1Division of NeuroInterventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
  3. 3Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Joshua A Hirsch, Division of NeuroInterventional Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; hirsch{at}snisonline.org

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Vertebral augmentation (VA) is a minimally invasive, imaging-guided procedure with deep roots in the NeuroInterventional community. In the USA, this procedure has been performed primarily for painful osteoporotic compression fractures. Despite studies supporting its efficacy in malignant spinal fractures, it remains underutilized for this population of patients.1 One of the ironies of this development is the often forgotten fact that the first patient treated at the University of Virginia had metastatic breast cancer.

Because of the fear of tumor displacement during treatment and potential compressive neurological compromise, our early experience was characterized by: (1) advocating external beam radiation therapy in advance of treatment; (2) quoting to the patient a ‘relatively high’ 5%–10% procedural complication rate; (3) performing adjunctive procedures such as concurrent myelography to ensure no change in spinal canal patency during balloon inflation (for kyphoplasty) and polymethylmethacrylate (PMMA)deposition (for kyphoplasty and vertebroplasty).

While such concerns are well intentioned, they lead to a reluctance on the part of practitioners to extend this therapy to cancer patients in need. The accompanying article may ameliorate some of these concerns and provides a substrate for cautious enthusiasm. Our retrospective 5-year cohort suggests that cancer patients with vertebral compression fractures (VCFs) can achieve meaningful pain control from VA with an acceptably low risk of complication. We recognize the limitation of this type of retrospective analysis and look forward to the publication of the Cancer Patient …

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