Novel Technique for Percutaneous Vertebroplasty in the Treatment of Metastatically Involved Vertebral Bodies

摘要

Metastatic disease to the spine occurs in up to one third of all cancer patients. Over 50% of spinal metastases with neurologic manifestations in females are found to arise from primary breast neoplasms. Percutaneous vertebroplasty is a minimally invasive procedure designed to provide stability to structurally weakened vertebrae due to osteoporosis or lytic lesions. In percutaneous vertebroplasty, clinically significant complications occur predominantly in patients with spinal metastases. We proposed that this higher complication rate may be due to generation of elevated intervertebral pressures and movement of tumor tissue during the prophylactic (pre-fracture) injection of cement into vertebral bodies containing highly incompressible lytic lesions. We hypothesized that removing tumor prior to or during the injection of bone cement can reduce pressures and tumor extravasation. Consequently, this may improve the filling pattern, resulting in improved spinal stability. This work aims to develop a novel method for percutaneous tumor ablation and to quantify its ability to improve vertebroplasty results in metastatically involved vertebrae. The results of this study will provide a basis for clinical investigations into the improvement of vertebroplasty techniques and outcomes for patients treated prophylactically for spinal metastases.