Percutaneous vertebroplasty for pain management in spinal metastasis with epidural involvement

Percutaneous vertebroplasty (PVP) has been widely used for the treatment of painful malignant lesions of the spine. Spinal metastasis with epidural involvement, with or without symptoms of neurologic compression, is regarded by some authors as a contraindication or relative contraindication to the procedure. To evaluate safety and effectiveness of PVP in pain management of spinal metastasis with epidural involvement, we retrospectively analyzed PVP in 32 patients with metastatic disease, who presented with at least one vertebral lesion with destruction of the posterior vertebral body wall or epidural extension of tumor. Among these patients, nine had signs of spinal cord or cauda equina compression. Procedural safety was evaluated by any post-procedure adverse events. The PVP analgesic efficacy was evaluated by follow-up neurological examination. Pain intensity was scored on a visual analog scale scored from 0 (no pain) to 10 (maximum pain intensity). The effective pain relief was defined as at least 50% improvement in pain score as compared with pre- procedure baseline. Follow-up assessments were performed at 1 day; 1 week; 1, 3, and 6 months after the procedure. Fifty-three vertebrae in 32 patients were treated in this group. Analgesic efficacy in survival patients was rated at 97% (31/32) at 1day and 1 week, 86.7% (26/30) at 1 month, 82.3% (24/29) at 3 months, and 76.9% (20/26) at 6 months after procedure. Leakage of PMMA was detected in 64% (33/53) treated vertebrae. No systemic complications were observed in all treated patients.