Vertebral augmentation significantly reduces pain in patients with cervical spinal metastases

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Vertebroplasty
Vertebroplasty

Rafael De la Garza-Ramos (Monterrey, Mexico, currently resident at Montefiore Medical Center, Bronx, USA) and others report in the International Journal of Spine Surgery that vertebral augmentation, either through vertebroplasty or kyphoplasty, is associated with a significant reduction in pain in patients with cervical spinal metastases. However, they note that this finding is based on “low quality evidence” and further studies are needed.

According to the authors, both vertebroplasty and kyphoplasty were associated with significant pain reduction in 94% of patients with pathologic vertebral compression fractures, but they note “most of these are performed in the thoracolumbar spine”. “This can be attributed to the fact spinal metastases are more common in this region, but also to the unique anatomy of the cervical spine,” De la Garza-Ramos et al write.

Therefore, in this meta-analysis, they reviewed the available data for efficacy and safety of vertebroplasty and kyphoplasty for pain relief in patients with cervical spine metastases. Overall, six case studies were identified, with five studies reviewing vertebroplasty and one reviewing kyphoplasty. In total, data were available for 120 patients (undergoing treatment at 135 vertebrae).

The authors report that the most commonly addressed level was C2 (61.5% of cases), commenting, “The reason for this higher prevalence of C2 in this study is unknown, but it has been hypothesised that given the higher risk of spinal cord injury in this region, the potential complications of instability at this level compared to caudal levels likely influences the decision to operate.”

Most patients (89%) had a significant improvement in pain following treatment. De la Garza-Ramos et al state, “The calculated average pain score decreased significantly from 7.6±0.9 before surgery to 1.9±0.8 at last evaluation (p=0.006). Patients were followed for an average of 10.7±6.3 months”.

Asymptomatic cement leak occurred in 22 vertebrae, and such leaks were predominantly found in the paraspinal soft tissues along the needle tract (18).

Noting that there was an absence of “high-quality” data in the literature for vertebral augmentation in patients with cervical spine metasteses, the authors state that is “insufficient data” in favour  of or against vertebroplasty or kyphoplasty for cervical metastases.

However, they add, “Based on the current analysed data, there is grade C evidence (low quality) suggesting that vertebroplasty/ kyphoplasty achieves significant reductions in pain scores with a low perioperative pain rate.” To confirm these findings, De la Garza-Ramos et al conclude, future randomised controlled trials are needed.