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Review
Percutaneous Vertebral Augmentation in Metastatic Disease: State of the Art
Flavio Tancioni MD, Martin A. Lorenzetti MD
, 
, , Pierina Navarria MD, Federico Pessina MD, Riccardo Draghi MD, Paolo Pedrazzoli MD, Marta Scorsetti MD, Marco Alloisio MD, Armando Santoro MD and Riccardo Rodriguez y Baena MD [Author vitae]
Received 9 June 2010;
accepted 29 November 2010.
Available online 13 February 2011.
Abstract
Improvements in diagnosis and treatment have prolonged cancer survival, with a consequent increase in the incidence of spinal metastases and vertebral compression fractures with associated axial pain, progressive radiculomyelopathy, and mechanical instability. Pain relief in malignant vertebral compression fractures is key to achieving a better quality of life in patients under palliative care. The gold standard for pain relief is nonsteroidal anti-inflammatory drugs and opioids. Nonresponsive cases are then treated with radiotherapy, which may require 2–4 weeks to take effect and in most cases does not provide complete pain relief. Percutaneous vertebroplasty and percutaneous kyphoplasty can in particular give relief in patients with vertebral body compression fractures that do not cause neurological deficits but severely compromise quality of life because of intractable pain.
Article Outline
Multiple myeloma, lymphoma, and metastases from primary tumors can cause osteolytic lesions of the vertebral body in a significant number of patients.1 Neoplastic invasion of the vertebral body results in erosion of the cancellous network and can result in painful vertebral compressive fractures.
Further fracture progression can lead to pain, numbness, weakness, sensory deficits, neurological claudication, fecal or urinary incontinence, and hyperreflexia. As a result, vertebral metastases can be the cause of disability and significant morbidity in these patients.2
Pain relief in malignant vertebral compression fractures is a key element in achieving a better quality of life in patients under palliative care.
The gold standard for pain relief is pharmacological therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. Nonresponsive cases are then treated with radiotherapy. Radiotherapy, however, requires 2–4 weeks to take effect and does not achieve complete pain relief in most cases.3 Further, radiotherapy does not correct mechanical instability or bone compression. Moreover, its analgesic and antitumoral effects are limited by the toxicity risk to adjacent structures, such as the spinal cord, and it does not prevent the progression of a pathologic fracture.
