Percutaneous vertebroplasty for painful spinal metastasis: a good option for better quality of life

Corresponding author: Yoon-Hee Kim, M.D., Ph.D., Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: 82-42-280-7841, Fax: 82-42-280-7968, E-mail: [email protected] This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. CC Vertebral compression fracture (VCF) is one of the main causes of severe pain originating from the spine. Significant pain can lead to reduced physical activity and cause depression, deep vein thrombosis, pneumonia, and sores [1]. VCF is caused by osteoporosis, cancer (primary or metastatic cancer), or osteonecrosis. Treatments include bed rest, analgesics, back braces and other conservative treatments and more invasive procedures including percutaneous vertebroplasty (PVP) and open surgery [2]. In the recent guidelines of the Cardiovascular and Interventional Radiology Society, indications for PVP include: painful osteoporosis VCF refractory to medical treatment for the duration of more than 3 weeks, painful vertebrae due to aggressive primary bone tumor (hemangioma, giant cell tumor), painful vertebrae with extensive osteolysis due to malignant infiltration (multiple myeloma, lymphoma, metastatic cancer), painful fracture associated with osteonecrosis (Kummel’s disease), reinforcement of the pedicle or vertebral body prior to posterior surgical stabilization procedures and chronic traumatic fracture in normal bone with nonunion of fracture fragments or internal cystic changes [2]. PVP has recently been implied in malignant vertebral compression fractures (MVCF) with positive results. 90% of vertebral column tumors are caused by metastasis from other organs. The vertebral column is the most common site of metastasis within the skeletal system, with 70% of diagnosed patients showing bone metastasis [3]. Sites of metastasis break down to 60-80% in the thoracic spine, 1530% in the lumbar spine and <10% in the cervical spine [4]. In 30% of vertebral metastasis from solid tumors, VCF occurs by reduction of vertebral bone strength via osteoblastic or osteoclastic activity [5]. MVCF can lead to economic loss, severe pain, neurologic injury, decreased life quality and even death. In this edition of the Korean Journal of Anesthesiology, Seo et al. [6] reported the effectiveness of PVP at C7 for the treatment of painful metastasis. Patients with breast cancer metastasis at C7 afflicted with continuous severe weight-bearing neck pain despite radiation therapy underwent PVP via the anteromedial approach, which resulted in alleviated pain symptoms and increased physical activity. Therefore, PVP may be an option for the treatment of metastatic osteolytic vertebral lesions in the cervical spine for the purpose of alleviating intractable axial neck pain. Early diagnosis and treatment of MVCF can preserve the patient’s quality of life and the possibility of physical activities. Conventional treatments include surgery, chemotherapy, hormone therapy, and medical therapy. Although treatment can increase the median survival rate, for most patients, the purpose of treatment is reduction of pain, local disease progression, spinal instability, and neurologic complications. Pharmacotherapy using anti-inflammatory drugs (NSAID) and opioids are first used to treat pain but requires extended periods of bed rest. Since cancer and its treatment reduce the patient’s immunity and cause the patient to be in a hyper-coagulation state, prolonged bed rest may increase morbidity from infection, pneumonia, deep vein thrombosis, and pulmonary embolism [7]. External beam radiation therapy (EBRT) is effective against pain but requires at least 2 weeks to obtain results. Also, since