Bone filling mesh container in the treatment of thoracolumbar osteolytic metastases

English Keywords:Bone filling mesh container  Vertebroplasty  Thoracolumbar osteolytic metastases  Bone cement leakage

English Abstract:

  【Abstract】 Objectives: To explore the clinical outcomes of Bone Filling Mesh Container(BFMCs) in the treatment of thoracolumbar osteolytic metastases. Methods: A total of 48 cases(77 vertebral bodies) with thoracolumbar osteolytic metastases were applied with PVP from October 2012 to October 2016, in whom 23 cases with 37 vertebral bodies were performed traditional PVP(TPVP group), and 25 cases with 40 vertebral bodies were performed PVP by using bone filling mesh container(BFMCs group). There was no statistical difference in age, sex ratio and vertebral body distribution between the patients in two groups. The bone cement leakage was observed by the "C" arm fluoroscopy during surgery. The VAS score was used to assess the pain relief in the patients on the third day after operation. The Oswestry disability index(ODI) was used to assess the improvement of the activity ability. The reduction extent of the vertebral height was measured in X-ray and CT before discharge. Results: All patients were successfully operated, the success rate of puncture was 100%. There was no pulmonary embolism, paraplegia or perioperative death. In the TPVP group, bone cement leakage occurred in 18 vertebrae(48.6%, 18/37), but these patients had no clinical symptoms. There was no case of bone cement leakage in BFMCs group. All patients had pain relief within three days after surgery. The VAS score of TPVP group was decreased from 7.8±1.3(5-10) preoperatively to 2.4±1.4(1-4) postoperatively, and the VAS score of BFMCs group was decreased from 7.9±1.1(6-10) to 2.5±1.3(1-4). ODI score of TPVP group decreased from (73.4±4.6)% preoperatively to (23.6±4.3)% postoperatively, BFMCs group decreased from (74.6±4.9)% to (23.9±4.5)%. The VAS score and ODI of the two groups after operation were significantly different from those before operation(P<0.05), and there was no significant difference between the two groups preoperatively and postoperatively. Postoperatively, increasing ratio of anterior vertebral body was (3.2±2.6)% in the TPVP and (11.8±11.6)% in the BFMCs group. Increasing ratio of middle vertebral body was (5.4±4.1)% in the TPVP group and (22.1±14.7)% in the BFMCs group, there was significant difference between two groups(P<0.05). Conclusions: In the patients with osteolytic metastases in thoracolumbar spine, bone filling mesh container can significantly reduce the leakage rate of bone cement in PVP, and better restore the height of vertebral body. There was no significant difference in pain relief and activity improvement with TPVP.