Percutaneous vosertebroplasty for malignant spinal metastatic tumor with epidural involvement

Objective To evaluate the safety and clinical efficacy of percutaneous vertebroplasty( PVP) on patients with malignant spinal metastatic tumor with epidural involvement. Methods Fifty-three patients with malignant spinal metastatic tumor with epidural involvement were given PVP treatment. Patients were classified into two groups according to impairment classification of American Spinal Injury Association( ASIA). There were 25 patients without symptoms of neurological compression in group A and 28 patients with symptoms of neurological compression in group B. 13 G bone puncture needle was placed transpedicularly in the fractured vertebra,and then polymethyl methacrylate( PMMA) was carefully injected into the fractured vertebral body under continuous fluoroscopic monitoring. Achievement ratio of operation,analgesic effect and neural functional recovery were observed. Results The PVP procedures were technically successful and well-tolerated in all patients.Clinical assessment at the final follow-up found that pain in 21 patients was relieved,in four paitents was unchanged in group A,while pain in 12 patients was relieved,in eight patients was unchanged and in eight patients was aggratated in group B. The pain relief rate in group A was significantly higher than that in group B( 84. 0% vs 42. 9%,P 0. 05). ASIA impairment scale assessment at the final follow-up exhibited that there were five patients with symptoms of neurologic compression and 20 patients with no symptoms of neurologic compression in group A; 26 patients with symptoms of neurologic compression and two patients with no symptoms of neurologic compression in group B. The rate of no symptoms of neurologic compression in group A was higher than that in group B( P 0. 05). Conclusion PVP is a safe and moderately effective procedure for malignant vertebral compression fractures with epidural involvement,but it cann't be used as a conventional effective therapy for malignant vertebral compression fractures with symptoms of neurologic compression.