Percutaneous vertebroplasty for painful spinal metastasis with epidural involvement

Objective To evaluate the feasibility,safety,and efficacy of PVP in pain management of spinal metastasis with epidural involvement.Methods Thirty-six patients with spinal metastatic disease were retrospectively analyzed,who presented each with one vertebral lesion with destruction of the posterior vertebral body wall or epidural extension of tumor.Among these patients,ten had signs of spinal cord or cauda equina compression.Fifty-nine vertebrae in 36 patients were treated in this group.Procedural safety was evaluated by any post-procedure adverse events.The PVP analgesic efficacy was evaluated by follow-up neurological examination.The effective pain relief was defined as at least 50% improvement in pain score(visual analogue scale,VAS)as compared with pre-procedure baseline.Follow-up assessments were performed at 1 day;1 week;1,3,and 6 months after the procedure.Results Analgesic efficacy in survival patients was rated at 97.2%(35/36)at 1 day and 1 week,88.2%(30/34)at 1 month,84.4%(27/32)at 3 months,and 75.0%(21/28)at 6 months after procedure.Leakage of PMMA was detected in 59.3%(35/59)treated vertebrae.No systemic complications were observed in all treated patients.Conclusions PVP is a feasible,safe,effective and minimal invasive procedure for painful spinal metastasis with epidural involvement.Epidural involvement with or without neurological signs of spinal cord or cauda equina compression should not be a contraindication to performance of PVP in patients with spinal metastasis.