Kyphoplasty for the treatment of malignant vertebral compression fractures caused by metastases

Despite the literature supporting the efficacy of kyphoplasty for treatment of osteoporotic vertebral compression fractures in multiple myeloma, few reports exist documenting its use in the treatment of malignant vertebral compression fractures (MVCF) caused by metastases. Accordingly, we sought to evaluate the feasibility, efficacy and safety of kyphoplasty in the treatment of MVCF without epidural involvement. We performed a retrospective review of clinical outcome data for 48 patients with multiple spinal metastases treated with kyphoplasty. Outcome data (vertebral body height variation, degree of kyphosis, visual analog scale score for pain, Oswestry Disability Index score, the Short Form-36 [SF-36] questionnaire score for function) were collected preoperatively, postoperatively, and at 1 month, 6 months, 1 year, and 2 years after treatment. Significant improvements in all of the outcome measures were observed postoperatively and throughout the duration of follow-up. The mean anterior vertebral body height variation improved from 52.7 ± 16.8% preoperatively to 85.3% ± 13.2% postoperatively (p < 0.001). Kyphotic angle improved from 16.4° ± 4.7° preoperatively to 8.4° ± 2.5° postoperatively (p < 0.001). The mean visual analog scale score decreased significantly from presurgery to postsurgery (7.4 ± 2.1 to 3.8 ± 1.6; p<0.001), as did the Oswestry Disability Index score (71.5 ± 16.7 to 32.4 ± 9.6; p<0.001). The SF-36 scores for bodily pain, physical function, vitality, and social functioning all also showed significant improvement (p<0.05). Kyphoplasty is an effective, minimally invasive procedure for the stabilization of pathological vertebral fractures caused by metastatic disease, even in levels with vertebral wall deficiency, leading to a statistically significant reduction in pain, improvement in function and prevention of further kyphotic deformity of the spine.