Supportive care aspects of vertebroplasty in patients with cancer

Minimally invasive vertebroplasty involves the percutaneous injection of polymethylmethacrylate bone cement into a fractured vertebral body. Although most frequently performed for osteoporotic compression fractures, vertebroplasty has also been very effective in the palliation of back pain secondary to osteolytic metastases and myeloma bone disease. The mechanism of pain relief is unclear; however, stabilization of microfractures and restoration of vertebral body strength is the leading theory. The decision to perform vertebroplasty is made after multiple factors are considered, including clinical presentation, medical fitness, functional capacity, tumor type, location and extent of disease, anticipated radiation sensitivity, and quality of life. Cement extravasation beyond the vertebral body is the most frequent complication; however, it is asymptomatic in the vast majority of patients. In the cancer setting, vertebroplasty is used as an adjunct to other standard treatments, including medical therapy, radiation therapy, chemotherapy, and surgery. In well-selected patients, vertebroplasty offers rapid relief of axial back pain and the potential for improved function.