Percutaneous vertebroplasty vs open surgery for spinal metastasis

English Keywords:Spine  Metastasis  Surgery  Percutaneous vertebroplasty

English Abstract:

  【Abstract】 Objectives: To investigate the surgical indications, outcomes and complications of percutaneous vertebroplasty(PVP) vs open surgery for spinal metastasis and to discuss the surgical protocol selection. Methods: ８７ patients(including solitary metastasis following primary tumor removal, spine canal encroachment by tumor, and violation to the spine stability) experiencing open surgery and ９０ patients(including no remarkable neurological deficit, no suitable for open surgery） undergoing percutaneous vertebroplasty between April 2004 and April 2011 were reviewed retrospectively. VAS score, ECOG score and Frankｅl scale were used to evaluate the pain and neurofunction between two groups. Kaplan-Meier method was used to determine the survival rate between 2 groups. Results： A total of 242 vertebrae underwent PVP with the median surgical time of 70min, VAS score decreased significantly at 2 days after PVP, which maintained till 6 months later; ECOG score at 1 week and 3 months decreased significantly; 91 of 242 vertebrae suffered from asymptomatic bone cement leakage; the median survival time was 16 months. While for open surgery, the median surgical time was 240 minutes with the median blood loss of 1600ml; VSA score at 1 month decreased significantly, which maintained till 6 months; ECOG score at 1 week and 3 months decreased significantly; 83% of the cases complicated with neurological deficit had Frankｅl scale improved; 29% cases with complete paraplegia and 60% with incomplete paraplegia had neurofunction recovered completely; complications were noted in 17 cases(19.5%), and peripheral surgical death was noted high(3.4%); the median survival time was 11 months. Conclusions： PVP is indicated for pain and mild-to-moderate instability due to spine metastasis, while open surgery is indicated for neurological deficit and severe instability due to solitary spine metastasis following primary tumor removal.