Original PaperSafety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review
Introduction
Percutaneous vertebroplasty was first described by Galibert and colleagues in 1987 as a minimally invasive treatment of painful vertebral haemangioma.1 Since then, the use of vertebroplasty has expanded to include treatment for osteoporosis, spinal metastasis, and rarely in traumatic fractures. Vertebroplasty for malignancy is attractive as an adjunct to radiotherapy or chemotherapy due to its rapid efficacy in patients with intractable pain.
Vertebroplasty has been shown to be safe with few complications in the setting of osteoporosis.2, 3 Concern remains regarding an apparent increase in complication rates for vertebroplasty in cancer patients. This is based mainly on published case series and technical review articles reporting neuropathy requiring emergency decompression and procedure-related mortality.4, 5 The suggested reasons for an increased risk to patients with metastases include the loss of cortical integrity and tumour angiogenesis.5 Critical evaluation of the current evidence is needed to quantify the efficacy and safety of the procedure in the context of malignancy.
The aim of this study was to examine the safety and efficacy of vertebroplasty in malignancy, and to determine factors that may be associated with an increased risk of complications or reduced efficacy. Data were extracted and compiled based on available peer-reviewed publications to address these issues.
Section snippets
Materials and methods
MEDLINE (OVID), EMBASE (OVID) and CENTRAL databases were searched from inception to April 2010. No restrictions were placed on publication date within these databases. This review included English language studies only.
A search strategy was developed in collaboration with the University Subject Librarian using a combination of Medical Subject Headings (MeSH) and text words. Text words were truncated and were used to describe the intervention and disease; “vertebroplasty”, “cementoplasty”,
Results
Seven hundred and sixty abstracts were generated in the initial search. Forty-five papers were retrieved for evaluation, of which 29 were included for this review. Hand-searching identified one additional study (Fig. 1). One author was contacted for clarification of data between the benign and malignant cohorts, and the study was included.14 A summary of these studies is presented as a table of evidence (Table 1).
Of the 30 studies included, there was one randomized, controlled trial, seven were
Discussion
This systematic review of vertebroplasty in patients with spinal metastases and myeloma revealed a paucity of robust data, and heterogeneity of available information (Table 4). While meta-analysis was not possible secondary to this, this review has showed that serious complications of vertebroplasty in this patient group ranged from 0 to 11.5%.21 The mortality for the procedure ranged from 0 to 7%.29 An average cement volume of 4 ml or greater may be associated with a higher complication rate
Acknowledgements
The authors thank Dr Helen Marlborough (Glasgow University Subject Librarian) for her help in developing the search strategy. Mr David Young (Department of Statistics, Strathclyde University) for his assistance. Dr E. Chow14 (Sunnybrook Regional Cancer Centre, Toronto University) for his correspondence and clarification.
References (38)
- et al.
Vertebroplasty: clinical experience and follow up results
Bone
(1999) - et al.
Successful salvage using percutaneous vertebroplasty in cancer patients with painful spinal metastases or osteoporotic compression fractures
Radiother Oncol
(2004) - et al.
CT fluoroscopy-guided percutaneous vertebroplasty for the treatment of osteolytic breast cancer metastases: results in 62 sessions with 86 vertebrae treated
J Vasc Interv Radiol
(2008) - et al.
The efficacy of percutaneous vertebroplasty for vertebral metastases associated with solid malignancies
Eur J Cancer
(2009) - et al.
Percutaneous transpedicular vertebroplasty with polymethylmethacrylate for pathological fracture of the spine
J. Clin. Neurosci
(2009) - et al.
Phase I/II clinical study of percutaneous vertebroplasty as palliation for painful malignant vertebral compression fractures: JIVROSG-0202
Ann Oncol
(2009) - et al.
Treatment of metastatic spinal tumors by percutaneous vertebroplasty versus percutaneous vertebroplasty combined with interstitial implantation of 125I seeds
Acta Radiol
(2009) - et al.
Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidence-based review of the literature
Spine J
(2009) - et al.
Preliminary note of the treatment of vertebral angioma by percutaneous acrylic vertebroplasty
Neuro-Chirurgie
(1987) - et al.
A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures
NEJM
(2009)