Percutaneous vertebroplasty in the treatment of malignant spine disease

Percutaneous vertebroplasty is a minimally invasive, radiologically-guided interventional procedure originally developed in France for the treatment of painful vertebral hemangiomas. The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of an acrylic polymer to provide bone augmentation and prevent further collapse. The internal "casting" of the trabecular microfractures results in pain relief and vertebral consolidation. Vertebroplasty was quickly adopted for use in metastatic vertebral lesions and hematologic malignancies such as multiple myeloma and lymphoma. The major experience with malignant disease has remained primarily in the European realm; in the United States vertebroplasty is used mainly for the treatment of osteoporotic compression fractures. The reasons underlying this divergence in practice experiences remains unclear, although the explosion of vertebroplasty in the U.S. appears to be driven by an assertive, motivated and well-informed elderly population. In addition, malignant lesions are often challenging and practitioners may shy away from these clinically and technically more difficult patients. The purpose of this article is to introduce the principles of percutaneous vertebroplasty to the North American oncologic community with the hope that it mayfind a greater role in the treatmentof malignant disease affecting the spine.