Efficacy and safety of vertebral stenting for painful vertebral compression fractures in patients with metastatic disease

• Published in: Neurological research (New York) 2014-12, Vol.36 (12), p.1086-1093
• Main Authors: Itshayek, Eyal, Fraifeld, Shifra, Vargas, Andres A., Schroeder, Josh, Kaplan, Leon, Barzilay, Yair, Rosenthal, Guy, Shoshan, Yigal, Cohen, José E.
• Format: Article
• Language: English
• Subjects: Back Pain - etiology; Back Pain - therapy; Fractures, Compression - etiology; Fractures, Compression - surgery; Humans; Kyphoplasty - methods; Kyphoplasty - standards; Male; Metastatic disease; Pain; Pain Measurement; Spinal Fractures - etiology; Spinal Fractures - surgery; Spinal Neoplasms - complications; Spinal Neoplasms - secondary; Stents; Titanium - therapeutic use; Treatment Outcome; Vertebral augmentation; Vertebral compression fracture; Vertebral stenting
• ISSN: 0161-6412; 1743-1328
• DOI: 10.1179/0161641214Z.000000000459

Background and Purpose: Painful vertebral compression fractures in cancer patients reduce quality of life and may limit survival. We assessed pain relief, vertebral height restoration, and kyphosis correction following vertebral augmentation using a novel expandable titanium stent implant in cancer patients with painful vertebral compression fractures. Materials and Methods: Patients >18 years of age with metastatic disease who presented symptomatic compression fractures of vertebral bodies T5-L5, with or without a history of osteoporosis, were included in the study. Back pain at presentation, immediately after vertebral stenting, and at 1-, 3-, 6-, and 12-month follow-up was estimated using the visual analog scale (VAS). Vertebral height and local kyphotic angle (alpha angle) were measured on lateral standing X-ray before and 1-3 months after stenting. Results: Forty-one cancer patients with painful vertebral compression fractures underwent vertebral stenting procedures at 55 levels. There was no perioperative mortality and no significant complication. Median preoperative VAS was 8·0 (range 8-10), falling to 2·0 immediately postop (range 1-6, P  =  0·000) and 0 at all subsequent follow-up (P ≤ 0·012). Mean preoperative vertical height loss was 25·8% (range 0-84·0%) versus a postoperative mean of 18·0% (range 0-66·0%, P  =  0·000). Median pre- and postoperative kyphotic angle improved from 8·3° (range 0·2°-54·0°) to 7·1° (range 0·2°-25·0°, P  =  0·000). Wilcoxon signed rank test or student's t-test was used for comparisons. Conclusions: Vertebral augmentation using a novel vertebral stenting system provided immediate and enduring pain relief and improved vertebral height loss and kyphotic angle.