Percutaneous Vertebroplasty Relieves Pain in Cervical Spine Metastases

Abstract

Percutaneous vertebroplasty (PVP) has been shown to release spinal pain and stabilize the vertebral body. PVP is suggested as an alternative treatment in spinal metastasis. Although cervical metastases is less prevalent than thoracic and lumbar spine, PVP procedure in cervical vertebrae remains technical challenging. We retrospectively analyzed the data from patients (n = 9) who underwent PVP using anterolateral approach to treat severe neck pain and restricted cervical mobility from metastatic disease. Patients were rated using modified Tokuhashi score and Tomita score before the procedure. Visual analog scale (VAS), neck disability index (NDI), analgesic use, and imaging (X-ray or CT) were evaluated before PVP and 3 days, 3 months, and 6 months after PVP. All patients were in late stage of cancer evaluated using modified Tokuhashi and Tomita score. The cement leakage rate was 63.6% (14 of the 22 vertebrae) with no severe complications. VAS, NDI, and analgesic use were significantly decreased 3 days after the procedure and remained at low level until 6 months of follow-up. Our result suggested PVP effectively released the pain from patients with cervical metastasis. The results warrant further clinical investigation.

Figure 1

(a) PVP was performed using anterolateral approach with all patients in supine position under general anesthesia or local anesthesia. (b) The target vertebra was located under the guidance of a C-arm digitalized X-ray machine. (c) Confirm the corrected position of the needle. (d) The injection was stopped when the cement filled up the lesion or any paraspinal leakage was observed.

Figure 2

(a) CT image of one patient after PVP was performed in 4 cervical spines. Cement leakage was observed at the right side of (b) C3 and (c) C4 and in the spinal canal of (d) C5.