Percutaneous vertebroplasty for painful spinal metastasis with epidural encroachment

BACKGROUND AND OBJECTIVES: Spinal metastasis with epidural encroachment is regarded by several authors to be a contraindication to percutaneous vertebroplasty (PVP) because of the risk of increasing symptomatic leakage of cement. This analysis aims to evaluate the safety and efficacy of PVP in patients with painful spinal metastasis and encroachment of epidural space. METHODS: A retrospective study was conducted to review 43 consecutive patients with spinal metastasis that underwent PVP, for a total of 69 affected levels. All patients had at least 1 level associated with epidural encroachment related to metastasis. Among these patients, 14 had signs of spinal cord or cauda equina compression. Pain intensity was scored on a visual-analog scale (VAS). The analgesic efficacy was defined as at least 50% improvement in pain score as compared with the pre-procedure baseline and post-procedure. Clinical improvement of neurological compressive symptoms was defined as a decrease in ASIA impairment scale from baseline of 1 point or more. RESULTS: The analgesic efficacy was achieved in 89.7% of survival patients at 1 month, 87.5% at 3 months, 86.9% at 6 months, and 84.6% at 1 year. Small amount cement leakages were detected in 69.6% of treated levels without clinical complications. No deterioration of spinal cord or cauda equina compression symptoms was observed after a PVP in any patients. The different grade of epidural encroachment of the lesions was not correlated with filling volume or extraosseous leakage (P > 0.05). The treated levels with epidural encroachment showed a statistically significant relationship to spinal-canal leakage (P < 0.05). CONCLUSIONS: PVP can be performed safely and effectively in patients with painful spinal metastasis and epidural encroachment.